What should the D9311 chart note include?
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Consultation with medical health care professional. Patient medical history reviewed. Consultation Details: Medical provider consulted: Medical provider consulted Practice/Hospital: Practice/Hospital Date of consultation: Date of consultation Method: Method Reason for Consultation: Dental procedure planned: Dental procedure planned Medical concern: Medical concern Medical consultation support: Medical professional contacted and reason Discussion details: Medication/medical issue discussed and recommendations received Clearance/instructions: Clearance status and medication instructions Information Requested: Medical clearance for dental procedure. Antibiotic prophylaxis recommendations. Medication management. Bleeding risk assessment. Anesthesia considerations. Patient Medical Information Discussed: Current diagnoses: Current diagnoses Current medications: Current medications Recent labs/tests: Recent labs/tests Recent procedures/hospitalizations: Recent procedures/hospitalizations Recommendations Received: Medical Clearance Status: Cleared with modifications: Cleared with modifications Medication Instructions: Continue medications: Continue medications Hold medications: Hold medications Resume medications: Resume medications Written documentation received and filed in patient chart. NV: Next visit
What documentation is required for D9311?
A defensible D9311 chart note has to prove a real provider-to-provider conversation happened, what was discussed, and how it changed the dental plan. Required elements:
- Identity of the medical provider consulted — full name, credentials (MD, DO, NP, PA, RN), specialty, and practice/hospital. "Dr. Smith's office" is not enough.
- Provider NPI — capture when available; many payers and audit reviewers expect it for D9311 specifically because it's the cleanest proof the consult was with a credentialed clinician.
- Date and time of the consult — the date the conversation occurred, not the date you saw the patient.
- Method of communication — phone, secure portal message, fax, written letter, or in-person. If by phone, note the call duration; if by message, that the written response is filed in the chart.
- Reason for the consult — the planned dental procedure or the finding that triggered the call (e.g., "planned extraction #18, #19, #30, #31; patient on apixaban 5 mg BID for atrial fibrillation").
- Specific medical information discussed — current diagnoses, current medications with dose and frequency, recent labs (INR, HbA1c, platelet count, CBC, kidney function), recent procedures or hospitalizations, and any new concerns identified.
- Clinical question asked — what you wanted the medical provider to answer (continue/hold anticoagulant? safe to extract? prophylactic abx needed? clearance for sedation?).
- Recommendation received — the medical provider's actual response in their words, including any conditions ("OK to proceed if INR <3.0," "hold apixaban for 24 hours pre-op and resume that evening," "no antibiotic prophylaxis needed per current AHA guideline," "prefer to defer extraction until patient is 3 months post-stent").
- Clinical decision impact — how the recommendation changed your dental plan. This is the line auditors look for. "Discussion confirmed plan unchanged" is acceptable; "Per Dr. Patel's recommendation, deferred extraction 30 days; will reassess after dual antiplatelet therapy ends" is stronger.
- Written confirmation — when the consult is by phone, request and file a written follow-up (faxed letter, portal message, or written summary signed by the medical provider). Several payers and state Medicaid plans require the written documentation in the chart for D9311 to pay.
- Patient communication — that the patient was informed of the consult outcome and consented to the revised plan.
- Provider signature and date.
D9311 is a "by report" cognitive code in spirit — the written note carries the entire claim. Pre-print boilerplate that doesn't identify the medical provider, the actual question, and the actual recommendation is the single biggest reason claims fail review. Cite the provider's own words when they're brief and unambiguous; that closes the loop.
Why does D9311 get denied?
The most common reasons D9311 is denied, downgraded, or audited:
- Missing identity of the medical provider — no provider name, no specialty, no practice; the auditor can't confirm the consult occurred
- Missing or vague NPI — carriers increasingly expect NPI capture for D9311; absent NPI is a flag on Medicaid policy reviews
- No date of the consult — the date the conversation actually happened must be in the note
- No method of communication — failure to document phone, secure message, fax, or in-person
- Generic, copy-pasted consult language — "Spoke with PCP, no concerns" without the actual question or recommendation reads as boilerplate and is rejected
- No impact on the dental plan — the recommendation is documented but the chart never says how it changed (or didn't change) the planned treatment
- No written follow-up filed — phone consults submitted without the subsequent written confirmation from the medical provider
- Bundled into the same-day procedure — D9311 billed on the same date as the extraction/implant/sedation it supported and bundled by the carrier into the global value
- Coverage carve-out — plan simply doesn't list D9311 as a covered benefit; documentation is fine, but reimbursement isn't available under that contract
- Same-day conflict with D9310 — both consult codes billed on the same DOS; only one consult code pays per encounter
- D9311 used for routine MH review — billing the code for the standard medical-history update at every recall; this is part of the evaluation code, not a separate consult
- D9311 used for staff-to-staff verification — front-desk insurance verification or RN-to-RN scheduling calls are not the dentist-initiated consult D9311 contemplates
- No patient consent / awareness — chart doesn't reflect that the patient knew the consult was happening or was informed of the outcome
What do practices ask about D9311?
What's the difference between D9310 and D9311?+
D9310 is a consultation by a dentist (or dental specialist) other than the requesting dentist — the classic specialist consult, dentist-to-dentist. D9311 is a consultation between the dentist and the patient's medical provider (MD, DO, NP, PA, RN). The defining question is who is on the other end of the conversation. An endodontist or oral surgeon = D9310; a cardiologist, oncologist, hematologist, or PCP = D9311. They are not interchangeable.
Is D9311 covered by insurance?+
Coverage is inconsistent. D9311 is recognized in CDT (added in 2018) and is documented broadly across plans, but many PPOs and most Medicaid programs either don't cover it or bundle it into the global value of the dental procedure that follows. When uncovered, the documentation is still valuable and the code can be billed to the patient with prior disclosure. When covered, payers typically require provider name, NPI when available, date, content of the discussion, and the impact on the dental plan.
What documentation does D9311 require?+
At minimum: the medical provider's name and credentials, NPI when available, specialty, practice or hospital, date and method of the consult (phone, secure message, fax, in-person), the clinical question asked, the recommendation received in the provider's own words, and a note on how the recommendation changed (or didn't change) the dental treatment plan. For phone consults, request a written confirmation from the medical provider and file it in the chart — several carriers require it.
Can D9311 be billed on the same day as the procedure it supported?+
It can be billed, but most carriers bundle D9311 into the global value of the same-day surgical or sedation procedure (D7140, D7210, D6010, D9223, D9243). When feasible, document and bill D9311 on the actual date the consult conversation occurred — typically days or weeks before the procedure — to avoid the bundle. The CDT descriptor doesn't restrict same-day billing, but reimbursement reality often does.
Does D9311 cover talking to a nurse or PA, or only a physician?+
The CDT descriptor refers broadly to a 'medical health care professional,' which most carriers and the ADA interpret to include MDs, DOs, NPs, PAs, and RN case managers acting on behalf of the medical provider. The conversation must still be substantive (a real clinical exchange with someone who has authority over the patient's medical care) — front-desk schedulers and insurance verification calls do not qualify.
Can the front-desk team bill D9311 for verifying medical history with the PCP's office?+
No. D9311 is dentist-initiated and requires the dentist's substantive involvement in the clinical conversation. Routine medical-history confirmation, insurance verification, or scheduling calls handled at the front desk are not D9311. If staff facilitate the call but the dentist conducts the clinical exchange (and the chart reflects it), the code can still apply.
Is D9311 appropriate for MRONJ-risk patients before extractions?+
Yes — MRONJ clearance is one of the highest-yield uses of D9311. Document the medical provider consulted (typically the prescribing oncologist or endocrinologist), the specific antiresorptive or antiangiogenic drug, dose, route (oral vs IV), duration of therapy, the surgical site planned, and any recommendations on a drug holiday, sequencing, or alternative non-surgical management. The 2022 AAOMS position paper and current ADA guidance both emphasize the dentist-to-prescriber consult as a standard of care.