The best narrative to submit is the one the provider wrote in the chart as to why the patient needed nitrous oxide CDT code D9230. If nitrous was used in behavior management it should be accompanied with code D9920, below is an explanation of when behavioral management should be used.

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.

The following process should be documented clearly in the patients chart as well:
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