Dentist referred me to an oral surgeon who was out of network so I choose a different surgeon. I had a referral to the first oral surgeon but not for the actual provider seen. My initial visit was coded as D9310 which is not covered by my insurance, the dentist had already established the diagnosis and recommended treatment. A second opinion or consultation between surgeon and dentist was not requested or needed. Shouldn’t they have used D0160.

I should note, I had to schedule with another oral surgeon as my treatment plan documented only the lowest cost procedure out of eight as covered by insurance and the other seven procedures shown as not covered. They refused to send treatment plan and necessary documention to my dental insurance for a pre-determination and expected me to pay approximately $4,000 up front and they would refund me any difference. I had serious doubt that the required documentation would be submitted with the claim. Additionally, they are withholding a percentage of my initial deposit as I had cancelled my procedure which I am fighting.

I have done medical coding for many years but dental coding seems to be complicated.

Thank you!!!