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November 1, 2005
 
MEDICAID INFORMATION RELEASE MA05-37
 
TO:                 Dentists and Oral /Maxillofacial Surgeons
 
FROM:           Leslie M. Clement, Deputy Administrator
 
SUBJECT:      DENTAL:  DOCUMENTATION REQUIREMENTS FOR BILLING BEHAVIOR MANAGEMENT (D9920)
 
ADDITIONAL DOCUMENTATION WILL BE REQUIRED WHEN BILLING BEHAVIOR MANAGEMENT PROCEDURE CODE D9920, EFFECTIVE FOR DATES OF SERVICE ON OR AFTER 1/1/2006.
 
The Current Dental Terminology (CDT) code book defines code D9920 as “behavior management, by report” – May be reported in addition to treatment provided”. In order to provide Medicaid with more complete information about behavior management services billed to Medicaid, claims for D9920 (Behavior Management) will require providers to document actual services rendered.  For all D9920 claims with dates of service on or after 1/1/2006, please use the following process:
 
1.       Describe the highest level of behavior management technique used for the client in the comments field of your paper or electronic claim. Comments such as “additional staff and time”, “hand over mouth”, “papoose board” will be sufficient.
 
2.       In addition, when physical restraint(s), otherwise known as Protective Stabilization*, are used, document the following information in the client’s record (not on the claim form):

 
ð       An Informed Consent form of provider’s choice    
ð       Indication for stabilization   
ð       Duration of application
ð       Behavior management technique used
 
Failure to maintain documentation in the client record could result in recoupment of Medicaid’s payment for D9920.
 
It is not necessary to include attachments to your claim. Prior Authorization is not needed for D9920.

 
 

D9920 is to be used for situations when the client is developmentally disabled, mentally ill, or especially uncooperative and difficult to manage resulting in dental staff providing additional time, skill, and/or assistance to render treatment. Providers should not bill Medicaid for Behavior Management, D9920, for basic behavior guidance techniques such as positive reinforcement, parental presence or absence, or voice control methods of behavior management.
 
IDAHO MEDICAID PROVIDER HANDBOOK:
This information is in addition to information in Section 3.2.6 of the Idaho Medicaid Provider
Physician/osteopath handbook, which is available online at:
and Section 3.2.11 of the Idaho Medicaid Provider Dental Handbook, which is available online at:
 
If you have questions concerning this Information Release, please contact Arla Farmer, Bureau of Medicaid Policy, at (208) 364-1958 or by FAX at (208) 334-2465.
 
Thank you for your continuing participation in the Medicaid program.
 
LC/af
 
*Protective stabilization is the direct application of physical force to a patient, with or without the patient’s permission, to restrict his or her freedom of movement. Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Comprehensive Accreditation Manual for Hospitals. 2004-2005; pp, pc25-pc40.  Oakbrook Terrace, II.