When is D9920 used?
The D9920 dental code, formally known as "Behavior management, by report," applies when a patient's conduct requires additional time, focus, or extra staff to deliver dental care safely. This code works best for patients who cannot be handled through standard methods due to age-related factors, disabilities, anxiety disorders, or other behavioral difficulties. D9920 should not be used for typical child management or patients needing basic reassurance; instead, it's designated for cases where behavioral problems substantially affect treatment delivery.
D9920 Charting and Clinical Use
Accurate record-keeping is vital when using D9920 for billing purposes. Clinical notes must clearly outline the particular behavioral difficulties observed, management strategies implemented, and extra time or staff needed. Document whether additional personnel assisted, if frequent treatment pauses occurred, or if specialized communication methods were necessary. Typical situations involve treating anxious children with severe dental phobia, patients with intellectual disabilities, or people with medical conditions that limit cooperation. Always record why conventional behavior management failed and describe the measures taken to ensure safe treatment completion.
Billing and Insurance Considerations
Insurance companies frequently review D9920 claims carefully, making comprehensive and precise documentation critical. Include a detailed written explanation with your claim, describing the patient's behavioral difficulties, why extra management was necessary, and how it affected treatment duration. Provide supporting clinical notes and reference relevant medical conditions when applicable. Prepare for potential requests for more information or claim reviews; well-organized dental practices maintain narrative templates and systematic records to speed up this process. Check D9920 coverage during benefit verification, as coverage varies among insurance plans.
How dental practices use D9920
Take a 7-year-old child with autism who needs dental restoration work. Standard behavioral guidance proves ineffective as the patient becomes upset and uncooperative, requiring an extra dental assistant and frequent short pauses to finish treatment safely. The dentist records the patient's condition, details the behavioral management techniques applied, and notes the additional time needed. This situation warrants D9920 usage, and submitting the claim with thorough documentation and supporting records improves reimbursement chances.
Common Questions
Should D9920 be billed for all pediatric patients or only in certain situations?
D9920 should not be routinely billed for all pediatric patients. This code is specifically intended for cases where a child exhibits challenging behavior that requires substantial additional time, staff resources, or specialized interventions beyond what is normally expected for their age. Standard behavior management for typical childhood anxiety or minor restlessness does not warrant this code. It should only be used when disruptive behavior significantly interferes with treatment delivery and necessitates documented extraordinary measures.
Do insurance plans require preauthorization for D9920, and what steps should practices take?
Many dental insurance plans may mandate preauthorization for D9920, particularly when coverage is limited or specific age and diagnostic criteria apply. Dental practices should proactively contact the patient's insurance carrier prior to the scheduled appointment to confirm preauthorization requirements and secure written approval when necessary. Taking this preventive approach helps minimize claim rejections and facilitates more efficient reimbursement processing.
What should practices do when D9920 claims are denied or insurers request additional documentation?
When a D9920 claim faces denial or triggers requests for supplementary information, practices should carefully examine the Explanation of Benefits to identify the specific denial reason. The next step involves submitting a comprehensive appeal that includes a detailed letter explaining medical necessity, comprehensive clinical documentation, and supporting evidence such as time records or behavioral evaluations. Prompt and thorough responses to insurance company inquiries significantly improve the likelihood of achieving successful claim resolution.