Adjunctive General Services Section Professional Consultation

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Adjunctive General Services Section - Professional Consultation and Visits

Topic: Professional Consultation and Visits	Last Reviewed Date: 01/2003
Section: Adjunctive General Services	Policy No: 57
Revised/Effective Date: 01/2003	Next Review Date: 01/2005

IMPORTANT INFORMATION
This Dental Policy has been developed through consideration of generally accepted standards of dental practice, review of dental literature, dental necessity, and as appropriate, government approval.

Benefit determinations should be based in all cases on the applicable contract language. To the extent there are any conflicts between these guidelines and the contract language, the contract language will control.

The purpose of dental policy is to provide a guide to coverage. Dental policy is not intended to dictate to providers how to practice dentistry. Providers are expected to exercise their clinical judgment in providing the most appropriate care.

Description

Consultation (diagnostic service provided by dentist or physician other than practitioner providing treatment) (D9310):
Type of service provided by a dentist or dental specialist whose opinion or advice regarding evaluation and/or management of a specific problem may be requested by another dentist, physician or appropriate source. The dentist may initiate diagnostic and/or therapeutic services.

House/extended care facility call (D9410):
Includes visits to nursing homes, long-term care facilites, hospice sites, institutions etc. Report in addition to reporting appropriate code numbers for actual services performed.

Hospital call (D9420):
May be reported when providing treatment in hospital or ambulatory surgical center, in addition to reporting appropriate code numbers for actual services performed.

Office visit for observation (during regularly scheduled hours) - no other services performed (D9430)

Office visit - after regularly scheduled hours (D9440)

Case presentation, detailed and extensive treatment planning (D9450):
Established patient. Not performed on same day as evaluation.

Policy/Criteria
Procedure is in accordance with generally accepted standards of dental practice.

Administrative Guidelines
Case presentation D9450. Not a contract benefit. Considered educational.

Codes	Number	Description
CDT	D9000-D9999	See above

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	The Blue Cross and/or Blue Shield Plans comprising The Regence Group serve Idaho, Oregon, Utah and much of Washington state. The Regence Group and each of its affiliate Plans are independent licensees of the Blue Cross and Blue Shield Association.