billing C D A J O U R N A L , V O L 5 0 , Nº 6
Billing for Extra Time Needed to Treat Individuals with Special Needs Allen Wong, DDS, and Ellen Darius, RDH, MS, MPH
AUTHORS Allen Wong, DDS, EdD, has taught postdoctoral general dentistry for over 35 years in AEGD programs in the Bay Area, is the director of the University of the Pacific, Arthur A. Dugoni School of Dentistry’s hospital dentistry program and was the director of the Highland Hospital restorative implant program. He has lectured nationally and internationally in the areas of special care dentistry, rotary endodontics, implant restorations and minimally invasive dentistry. Conflict of Interest Disclosure: None reported.
Ellen Darius, RDH, MS, MPH, received her BS and MS in dental hygiene from the University of California, San Francisco. She spent several years as a dental hygienist in private practice and served as assistant clinical professor at the UCSF School of Dentistry. She participated in several research studies and received her MPH from UC Berkeley. She is passionate about increasing access to dental care for individuals with disabilities. Conflict of Interest Disclosure: None reported.
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he goal of health care is that it should be fair, respectful and inclusive for all individuals. The population of those with medical, physical, behavioral or developmental conditions is increasing in their lifespan and comorbidities. There are multiple barriers to accessing dental care for this population. When care is attained, it is often for severe dental needs requiring hospital dentistry. The obvious strategy to lessen costly outcomes is prevention. However, dental providers may be hesitant to provide preventive treatment to individuals with special needs because of the extra time required for these services. A new code, CDT Code D9920, was introduced that allows providers to be compensated for the extra time required to provide preventive care to this underserved population. While this billing code has been in effect for over two years, many dental providers are not using this code or are not being reimbursed because of insufficient documentation. If used correctly, this code provides a financial incentive of $140 up to four times per year. The purpose of this article is to offer guidance to practitioners as to how and when to use this code and
encourage providers to begin accepting individuals with special needs Code D9920 was established for “behavioral management” to help accommodate for the extra time necessary to properly treat patients with special needs. Behavior management, defined as a process by which dentists can help clients identify appropriate and inappropriate behavior, learn problem-solving strategies and develop impulse control, empathy and self-esteem, can be an effective alternative to costly and invasive procedures. When employed appropriately, behavior guidance results in more positive attitudes toward dentistry and lays the foundation for a lifetime of positive oral health experiences. Documentation must indicate specific techniques applied according to the individual client’s needs. This ensures that dental records include information on techniques that result in successful outcomes and aids providers in reproducing positive dental experiences for clients at future visits. With all billing codes, a concern for fraud is always present. Therefore, documentation of why extra time is needed is important along with a “billable” procedure. Code D9920 for behavior management allows usage of JUNE 2 0 2 2
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