Missed Appointment Template

Missed appointment.

Appointment Details:
Scheduled date: Scheduled date
Scheduled time: Scheduled time
Scheduled procedure: Scheduled procedure
Appointment duration: Appointment duration

Missed Appointment Documentation:
Patient did not present for scheduled appointment.
Advance notification: None or describe
Attempts to contact patient: Attempts to contact patient
Phone call: Phone call
Text message: Text message
Email: Email

Patient Contact (if reached):
Reason given: Reason given
Rescheduled: Rescheduled

Notes: Notes

Follow-Up Action:
Reschedule attempted.
Letter sent.
Added to recall list.

Documentation requirements

D9986 has no clinical descriptor — there is no procedure performed, no anesthetic, no tooth involved. The note exists to establish a defensible chart trail for three downstream uses: justifying a missed-appointment fee if your policy charges one, supporting a future dismissal-from-the-practice letter, and giving the front desk a record they can reference at the next call.

• Scheduled appointment details — date, time, scheduled procedure (e.g., "D2740 #14, 90 min"), and the appointment duration the chair was held. Without these, the chart entry is just a note that "something" was missed.
• Patient did not present — explicit statement that the patient failed to arrive. If they arrived late and were not seated, document the arrival time and the practice's late-arrival cutoff so the decision is on the chart.
• Advance notification — none, voicemail at [time], text at [time], or "patient called [time] after appointment start to cancel." This is the field that determines whether the entry is a true no-show vs a late-cancel and, in some practices, whether D9986 or D9987 applies.
• Contact attempts — phone call(s), text, and email with timestamps and outcome (left voicemail, no answer, replied, etc.). Two attempts is the typical floor; three is defensible.
• Patient response (if reached) — reason given in the patient's words when possible, whether the patient agreed to reschedule, and any explanation of practice policy regarding missed appointments.
• Follow-up action — rescheduled to [date], written warning letter sent, added to short-call/recall list, deposit required at booking, or — after a documented pattern — dismissal letter triggered.
• Reference to practice policy — note that the missed-appointment policy was reviewed with the patient if reached. If a fee is being charged, note the dollar amount and that the patient was previously informed of the policy in writing (intake paperwork or financial agreement).
• Operator initials and date/time of the entry. Front-desk staff (not the dentist) typically author D9986 entries; the chart should reflect who made the call attempts.

The "amnesia test" applies even to administrative entries: someone reading the chart in 18 months should be able to reconstruct exactly what happened, what the office did about it, and how the patient responded. A bare "NS" or "no-show" is not enough if the entry is ever referenced in a board complaint, fee dispute, or dismissal letter.

Common denial reasons

D9986 cannot be "denied" in the conventional sense — there is nothing to pay. The risks are different in shape:

• Carrier returns a zero-pay EOB. Submitting D9986 to insurance is a routine zero-pay; some practice management systems flag this as a denial, but it is the expected response.
• PPO contract violation when charging a contracted patient. Charging a no-show fee to a patient whose carrier contract prohibits it can result in carrier audit findings, refund demands, fee write-offs, or termination from the network. This is the highest-stakes risk associated with D9986.
• State board complaint when the fee is excessive or undisclosed. A missed-appointment fee charged without prior written disclosure (signed financial policy at intake) is the most common board-complaint trigger. Charging more than chair-time value invites review.
• Medicaid program integrity issue. Charging a Medicaid patient any out-of-pocket fee — including no-show fees — is generally a participation violation and can be referred to state Medicaid fraud control units.
• Small claims / collections risk. Sending an unpaid missed-appointment charge to collections without a strong written record (signed policy, D9986 entries with documented contact attempts) is a frequent source of small-claims counterclaims.
• Discrimination / retaliation exposure. Charging the fee inconsistently — applying it to some patients and waiving it for others — invites both board complaints and discrimination claims. Apply the policy uniformly or not at all.
• Missing chart trail when the practice later dismisses the patient. The most common consequence of not documenting D9986 entries is that a later dismissal letter looks arbitrary. Without chart D9986 entries, "habitual no-show" is unsupported.

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