Case Management for Special Needs - CDT Code Guide
Overview
CDT Code D9997 is designated for dental case management care tailored to patients with special health care needs. This code applies to individuals with physical, medical, developmental, or cognitive conditions that significantly limit their functional capabilities or result in incapacitation. For these patients, standard dental procedures may need to be adjusted to accommodate their unique requirements. This could involve modifying treatment plans or employing specialized techniques to ensure comprehensive oral health services are delivered effectively and safely. Dental professionals use this code to document the additional care and planning necessary to meet the needs of these patients, ensuring they receive the same quality of care as any other patient.
When to Use This Code
- When treating a patient with severe autism requiring sedation for dental procedures.
- For a patient with cerebral palsy needing modified positioning during treatment.
- In cases where a patient with Alzheimer's requires a simplified communication approach.
- When a patient with Down syndrome needs extended appointment times for dental care.
- For individuals with significant physical disabilities requiring specialized equipment.
Documentation Requirements
- Detailed patient medical history highlighting the special health care needs.
- Customized treatment plan outlining modifications made for the patient.
- Notes on any special equipment or techniques used during treatment.
- Documentation of communication with caregivers or other healthcare providers.
- Records of additional time spent planning and executing the treatment.
Billing Considerations
When billing for D9997, it's important to note that this code may not be covered by all insurance plans, as it is considered an adjunctive service. Check with the patient's insurance provider for coverage specifics. This code is typically used in conjunction with other procedure codes that describe the actual dental services provided. Frequency limitations may apply, so it's crucial to verify the patient's benefits and any prior authorizations required. Common modifiers might include those indicating the use of sedation or anesthesia.
Related CDT Codes
Frequently Asked Questions
D9997 should be used specifically for patients whose conditions require significant modifications to standard dental care procedures.
Need help with dental coding?
Our AI-powered assistant can answer your CDT code questions instantly.