D9310Consultation, Diagnostic Service Provided by Dentist or Physician Other Than Requesting Dentist or Physician

What This Code Covers

D9310 is used when a patient is referred by one dentist or physician to another provider specifically for a diagnostic opinion or evaluation. The consulting provider examines the patient, reviews relevant records and radiographs, and sends a written report back to the referring provider. The key distinction is that the consulting provider does not take over the patient's treatment. If the specialist begins treatment, the visit is no longer a consultation and the appropriate evaluation code (D0150 or D0140) should be used instead.

Billing Guide

Bill this code when:

• A patient is referred by another provider for a diagnostic opinion or second opinion
• The consulting provider evaluates the patient and prepares a written report for the referring provider
• The consulting provider does not initiate treatment during the consultation visit
• There is a documented referral from the requesting dentist or physician

Do not bill this code when:

• The patient self-refers or walks in without a referral from another provider
• The consulting provider begins treatment during the same visit. Bill the appropriate evaluation and treatment codes instead
• The visit is a standard new patient evaluation (D0150) or limited problem-focused exam (D0140)
• The provider is simply seeing an existing patient for a regular evaluation, not responding to a referral request

Insurance and Denial Prevention

Key Payer Rules:

• Many commercial plans cover D9310, but some require proof of a formal referral from another provider
• Some payers limit D9310 to one consultation per provider per patient per benefit year
• If the consulting provider later becomes the treating provider, D9310 still applies to the initial consultation visit as long as no treatment was rendered that day
• Medicaid coverage for consultations varies by state. Some state programs do not recognize D9310 and require billing an evaluation code instead

Common Denials and How to Respond:

• No referral on file → Submit the written referral from the requesting provider. If the referral was verbal, document it in the chart and include a narrative explaining the referral source with the appeal.
• Billed as evaluation instead → Some payers reclassify D9310 as D0150 or D0140. If the service was truly a consultation (no treatment, report sent back), appeal with the written report and referral documentation.
• Duplicate of evaluation code on same date → D9310 should not be billed alongside another evaluation code on the same date. If both appear on the claim, remove the evaluation code and keep D9310 if the visit was purely consultative.