MassHealth Updates Massachusetts League of CHC s Dental Forum

Transcription

1 MassHealth Updates Massachusetts League of CHC s Dental Forum Donna C. Jones, DMD, MPH MassHealth Dental Director University of Massachusetts Medical School Commonwealth Medicine-Office of Clinical Affairs October 3, 2018

2 Objectives Policy Updates Coding - D0180 Your Questions 2

3 POLICY 3

4 Year Policy Topic 2015 DEN-93 DEN-94 DEN-95 Dentures Appendix G Revision prep for ICD-10 Orthodontic Prior Auth- Appendix D 2016 DEN-96 Orthodontic- Appendix D- HLD score reduces from 28 to DEN-97 *Dental Services Appendix E & F a. General Definitions -Dentition(primary, transitional, adult) b. Diagnostic Evaluation (D0180) c. Assessment for PHDH (D0190, D0191) 2018 DEN-98 DEN-99 DEN-100 DEN-101 Updates Orthodontic Treatment Visits Orthodontic Treatment Visits Orthodontic CDT Revised Codes 5000 series and CPT 4

5 Policies In Progress Restoring Adult Periodontal Benefits (2010) July 26, The Governor signed the fiscal year 2019 budget into law, and did NOT veto the provision restoring periodontal care. Rate Increase for Behavior Management Code D9920 UMASS Medical School-Commonwealth Medicine- Office of Clinical Affairs 5

6 Choosing the Correct Code Evaluating and Treatment Planning. Dentists performs diagnostic evaluations o D0120, D0150, or D0180 Periodontal charting o Periodontal Screening& Recording (PSR) o Periodontal Evaluation (D0180) Treatment Plan- Non surgical, Surgical UMASS Medical School- Commonwealth Medicine Office of Clinical Affairs 6

7 Evaluation Codes Description Note: Diagnostic Services only performed by Dentist. D0120 Periodic Oral Exam 2 per calendar year, per provider, or location *Not covered with D9110 Patient: Established Patient of record Examination: determine changes in dental and medical health status since a previous assessment (D0120 or D0150), oral cancer screening, results from additional diagnostic procedures and periodontal screening (if indicated). D0150 Comprehensive Oral Evaluation 1 per lifetime, per provider, or location * Not covered with D0180 D0180 Comprehensive Periodontal 1 per calendar year(s) per provider or location. Commonwealth Medicine Patient: New or Established Patients Comprehensive Examination: dental/medical history, dental and periodontal charting, includes intra/extraoral soft tissue and hard tissue exam, anomalies, significant change(s) in health conditions, unusual circumstances by report, 3 or more years of inactive treatment and oral cancer screening. Patient: New or Established Patients Comprehensive Periodontal Examination: dental/medical history, probing and charting, patients with risk factors such as smoking, diabetes; may also include evaluation and recording of dental caries, missing or unerupted teeth, 7 restorations, occlusal relationships and oral cancer screening.

8 Healthy Gums and Gum Disease 8

9 Gingival Index The Gingival Index of Löe and Silness defines gingival inflammation as follows: 0 = normal gingiva 1 = mild inflammation- slight change in color and slight edema but no bleeding on probing 2 = moderate inflammation- redness, edema, and glazing, bleeding on probing 3 = severe inflammation- marked redness and edema, ulceration with tendency to spontaneous bleeding Grellmann AP and Zanatta FB. Diagnosis of Gingivitis: State of the Art. J Dent & Oral Disord. 2016; 2(3): ISSN:

10 New Periodontal Classification November 2017 American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) updated the 1999 classification of periodontal disease and conditions. New classification clarifies the stage, extent, and progression with anticipated treatment response. The staging is based on both severity and complexity of management. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4(1):1-6. doi: /annals ybwqybbxqerfbdutcavvzvu. Caton G, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri implant diseases and conditions Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018;45(suppl 20):S1-S8. doi: /jcpe

11 Commonwealth Medicine 11

12 ACO MassHealth members receive dental care benefits through a contracted Third Party Administrator (currently DentaQuest) as described in the MassHealth dental program regulations. MassHealth promotes the integration of oral health and quality of oral health care through a range of methods (e.g., inclusion of oral health metrics in the ACO quality measure slate, contractual expectations for ACOs). Members enrolled in ACOs, dental services remain FFS and associated dental costs are not counted against the ACO total cost of care budget. HCFA and Community Catalyst (CC) have been selected by MassHealth to provide technical assistance (TA) to ACOs and their community partners seeking help in integrating oral health into their broader health care program. UMASS Medical School -Commonwealth Medicine-Office of Clinical Affairs 12

13 Topic More Questions and Answers Resource X-rays D0210 Can you comment on New patient appointments for FMX/radiographs only, followed by 2nd visit for comprehensive exam (with regards to best practices)? Office Reference Manual Appendix E A%20News/Files/Dental_Radiographic_Examinations _2012.pdf?la=en Rate Increases What is outlook for increased rates from MassHealth and HSN? TBD UMASS Medical School -Commonwealth Medicine-Office of Clinical Affairs 13

14 ADA Code of Ethics Section 5 Principle: Truthfulness Code For What You Do, and Do What You Coded For. 14

15 Thank You On behalf of the MH agency, I would like to extend my sincere appreciation to all of you for your ongoing dedication to providing quality care to MassHealth members.your Patients. Donna C. Jones, DMD, MPH Dental Director MassHealth donna.jones@state.ma.us 15