Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-535 - Dental-related services › GENERAL › Section 182-535-1050 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The following definitions and abbreviations and those found
					 in chapter 182-500 WAC apply to this chapter. The medicaid agency also uses
					 dental definitions found in the American Dental Association's Current Dental
					 Terminology (CDT) and the American Medical Association's Physician's Current
					 Procedural Terminology (CPT). Where there is any discrepancy between the CDT or
					 CPT and this section, this section prevails. (CPT is a trademark of the
					 American Medical Association.)
"Access to baby and child dentistry (ABCD)"
is
					 a program to increase access to dental services for medicaid eligible infants,
					 toddlers, and preschoolers through age five. See WAC
					 182-535-1245
					 for specific information.
"Alternate living facility"
is defined in WAC
					 182-5131100.
"American Dental Association (ADA)"
is a
					 national organization for dental professionals and dental societies.
"Anterior"
refers to teeth (maxillary and
					 mandibular incisors and canines) and tissue in the front of the mouth.
					 Permanent maxillary anterior teeth include teeth six, seven, eight, nine, ten,
					 and eleven. Permanent mandibular anterior teeth include teeth twenty-two,
					 twenty-three, twenty-four, twenty-five, twenty-six, and twenty-seven. Primary
					 maxillary anterior teeth include teeth C, D, E, F, G, and H. Primary mandibular
					 anterior teeth include teeth M, N, O, P, Q, and R.
"Asynchronous"
means two or more events not
					 happening at the same time.
"Alveoloplasty"
means a distinct (separate
					 procedure) from extractions. Usually in preparation for a prosthesis or other
					 treatments such as radiation therapy and transplant surgery.
"Behavior management"
means using one
					 additional professional staff, who is employed by the dental provider or clinic
					 and who is not delivering dental treatment to the client, to manage the
					 client's behavior to facilitate dental treatment delivery.
"By-report"
means a method of reimbursement in
					 which the department determines the amount it will pay for a service when the
					 rate for that service is not included in the agency's published fee schedules.
					 Upon request the provider must submit a "report" that describes the nature,
					 extent, time, effort and/or equipment necessary to deliver the service.
"Caries"
means carious lesions or tooth decay
					 through the enamel or decay on the root surface.
*
"Incipient caries"
means the beginning
					 stages of caries or decay, or subsurface demineralization.
*
"Rampant caries"
means a sudden onset of
					 widespread caries that affects most of the teeth and penetrates quickly to the
					 dental pulp.
"Comprehensive oral evaluation"
means a
					 thorough evaluation and documentation of a client's dental and medical history
					 to include extra-oral and intraoral hard and soft tissues, dental caries,
					 missing or unerupted teeth, restorations, occlusal relationships, periodontal
					 conditions, (may include periodontal screening and/or charting), hard and soft
					 tissue anomalies, and oral cancer screening.
"Conscious sedation"
means a drug-induced
					 depression of consciousness during which a client responds purposefully to
					 verbal commands, either alone or accompanied by light tactile stimulation. No
					 interventions are required to maintain a patent airway, spontaneous ventilation
					 is adequate, and cardiovascular function is maintained.
"Core buildup"
means the building up of
					 clinical crowns, including pins.
"Coronal"
means the portion of a tooth that is
					 covered by enamel.
"Crown"
means a restoration covering or
					 replacing the whole clinical crown of a tooth.
"Current dental terminology (CDT)"
means a
					 systematic listing of descriptive terms and identifying codes for reporting
					 dental services and procedures performed by dental practitioners. CDT is
					 published by the Council on Dental Benefit Programs of the American Dental
					 Association (ADA).
"Current procedural terminology (CPT)"
means a
					 systematic listing of descriptive terms and identifying codes for reporting
					 medical services, procedures, and interventions performed by physicians and
					 other practitioners who provide physician-related services. CPT is copyrighted
					 and published annually by the American Medical Association (AMA).
"Decay"
means a term for caries or carious
					 lesions and means decomposition of tooth structure.
"Deep sedation"
means a drug-induced
					 depression of consciousness during which a client cannot be easily aroused,
					 ventilatory function may be impaired, but the client responds to repeated or
					 painful stimulation.
"Dental general anesthesia"
see
"general
					 anesthesia."
"Dentures"
means an artificial replacement for
					 natural teeth and adjacent tissues, and includes complete dentures, immediate
					 dentures, overdentures, and partial dentures.
"Denturist"
means a person licensed under
					 chapter 18.30 RCW to make, construct, alter, reproduce, or repair a
					 denture.
"Distant site (location of dental provider)"
means the physical location of the dentist or authorized dental provider
					 providing the dental service to a client through teledentistry.
"Edentulous"
means lacking teeth.
"Endodontic"
means the etiology, diagnosis,
					 prevention and treatment of diseases and injuries of the pulp and associated
					 periradicular conditions.
"EPSDT"
means the agency's early and periodic
					 screening, diagnostic, and treatment program for clients age twenty and younger
					 as described in chapter 182-534 WAC.
"Extraction"
see
"simple
					 extraction"
and
"surgical extraction."
"Fluoride varnish, rinse, foam or gel"
means a
					 substance containing dental fluoride which is applied to teeth, not including
					 silver diamine fluoride.
"General anesthesia"
means a drug-induced loss
					 of consciousness during which a client is not arousable even by painful
					 stimulation. The ability to independently maintain ventilatory function is
					 often impaired. Clients may require assistance in maintaining a patent airway,
					 and positive pressure ventilation may be required because of depressed
					 spontaneous ventilation or drug-induced depression of neuromuscular function.
					 Cardiovascular function may be impaired.
"Interim therapeutic restoration (ITR)"
means
					 the placement of an adhesive restorative material following caries debridement
					 by hand or other method for the management of early childhood caries. It is not
					 considered a definitive restoration.
"Limited oral evaluation"
means an evaluation
					 limited to a specific oral health condition or problem. Typically a client
					 receiving this type of evaluation has a dental emergency, such as trauma or
					 acute infection.
"Limited visual oral assessment"
means an
					 assessment by a dentist or dental hygienist provided in a setting other than a
					 dental office or dental clinic to identify signs of disease and the potential
					 need for referral for diagnosis.
"Medically necessary"
see WAC
					 182-500-0070.
"Mobile anesthesiologist"
means a provider
					 qualified to deliver moderate and deep sedation in an office setting other than
					 their own. The mobile anesthesiologist is a separate provider from the
					 clinician delivering dental treatment.
"Oral evaluation"
see
"comprehensive
					 oral evaluation."
"Oral hygiene instruction"
means instruction
					 for home oral hygiene care, such as tooth brushing techniques or
					 flossing.
"Originating site (location of client)"
means
					 the physical location of the medicaid client as it relates to
					 teledentistry.
"Partials"
or
"partial dentures"
mean a removable prosthetic appliance that replaces missing teeth on either
					 arch.
"Periodic oral evaluation"
means an evaluation
					 performed on a patient of record to determine any changes in the client's
					 dental or medical status since a previous comprehensive or periodic
					 evaluation.
"Periodontal maintenance"
means a procedure
					 performed for clients who have previously been treated for periodontal disease
					 with surgical or nonsurgical treatment. It includes the removal of
					 supragingival and subgingival microorganisms, calculus, and deposits with hand
					 and mechanical instrumentation, an evaluation of periodontal conditions, and a
					 complete periodontal charting as appropriate.
"Periodontal scaling and root planing"
means a
					 procedure to remove plaque, calculus, microorganisms, and rough cementum and
					 dentin from tooth surfaces. This includes hand and mechanical instrumentation,
					 an evaluation of periodontal conditions, and a complete periodontal charting as
					 appropriate.
"Posterior"
means the teeth (maxillary and
					 mandibular premolars and molars) and tissue towards the back of the mouth.
					 Permanent maxillary posterior teeth include teeth one, two, three, four, five,
					 twelve, thirteen, fourteen, fifteen, and sixteen. Permanent mandibular
					 posterior teeth include teeth seventeen, eighteen, nineteen, twenty,
					 twenty-one, twenty-eight, twenty-nine, thirty, thirty-one, and thirty-two.
					 Primary maxillary posterior teeth include teeth A, B, I, and J. Primary
					 mandibular posterior teeth include teeth K, L, S, and T.
"Prophylaxis"
means the dental procedure of
					 scaling and polishing which includes removal of calculus, plaque, and stains
					 from tooth structures and implants and is intended to control local irritation
					 factors.
"Proximal"
means the surface of the tooth near
					 or next to the adjacent tooth.
"Radiograph (X-ray)"
means an image or picture
					 produced on a radiation sensitive film emulsion or digital sensor by exposure
					 to ionizing radiation.
"Reline"
means to resurface the tissue side of
					 a denture with new base material or soft tissue conditioner in order to achieve
					 a more accurate fit.
"Resin-based composite restorations"
means
					 resinbased composite refers to a broad category of materials including, but not
					 limited to, composites. The category may include bonded composite, light-cured
					 composite, etc. Tooth preparation, acid-etching, adhesives (including
					 resin-bonding agents), liners and bases, and curing are included as part of the
					 restoration. Glass ionomers, when used as definitive restorations, should be
					 reported with resin-based composite codes.
"Root canal"
means the chamber within the root
					 of the tooth that contains the pulp.
"Root canal therapy"
means the treatment of
					 the pulp and associated periradicular conditions.
"Root planing"
means a procedure to remove
					 plaque, calculus, microorganisms, and rough cementum and dentin from tooth
					 surfaces. This includes hand and mechanical instrumentation.
"Scaling"
means a procedure to remove plaque,
					 calculus, and stain deposits from tooth surfaces.
"Sealant"
means a dental material applied to
					 teeth to prevent dental caries.
"Simple extraction"
means the extraction of an
					 erupted or exposed tooth to include the removal of tooth structure, minor
					 smoothing of socket bone, and closure, as necessary.
"Standard of care"
means what reasonable and
					 prudent practitioners would do in the same or similar circumstances.
"Surgical extraction"
means the extraction of
					 an erupted or impacted tooth requiring removal of bone and/or sectioning of the
					 tooth, and including elevation of mucoperi osteal flap if indicated. This
					 includes related cutting of gingiva and bone, removal of tooth structure, minor
					 smoothing of socket bone, and closure.
"Synchronous"
means existing or occurring at
					 the same time.
"Teledentistry"
means the variety of
					 technologies and tactics used to deliver HIPAA compliant, interactive, realtime
					 audio and video telecommunications (including webbased applications) or
					 store-and-forward technology to deliver covered services within the dental care
					 provider's scope of practice to a client at a site other than the site where
					 the provider is located.
"Temporomandibular joint dysfunction (TMJ/
					 TMD)"
means an abnormal functioning of the temporomandibular joint or
					 other areas secondary to the dysfunction.
"Therapeutic pulpotomy"
means the surgical
					 removal of a portion of the pulp (inner soft tissue of a tooth), to retain the
					 healthy remaining pulp.
"Usual and customary"
means the fee that the
					 provider usually charges nonmedicaid customers for the same service or item.
					 This is the maximum amount that the provider may bill the
					 agency.
11-14-075, recodified as §
												182-535-1050, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.500,
						74.09.520. 07-06-041, §
						388-535-1050, filed 3/1/07, effective 4/1/07. Statutory Authority:
						RCW
						74.04.050,
						74.04.057, and
						74.09.530. 04-14-100, §
						388-535-1050, filed 7/6/04, effective 8/6/04. Statutory Authority:
						RCW
						74.04.050,
						74.04.057,
						74.08.090,
						74.09.530, 2003 1st sp.s. c 25,
						P.L.
						104-191. 03-19-077, § 388-535-1050, filed
						9/12/03, effective 10/13/03. Statutory Authority:
						RCW
						74.08.090,
						74.09.035,
						74.09.500,
						74.09.520,
						42 U.S.C.
						1396 d(a),
						42 C.F.R.
						440.100 and
						440.225. 02-13-074, §
						388-535-1050, filed 6/14/02, effective 7/15/02. Statutory Authority:
						RCW
						74.08.090. 01-02-076, § 388-535-1050,
						filed 12/29/00, effective 1/29/01. Statutory Authority:
						RCW
						74.08.090,
						74.09.035,
						74.09.520 and
						74.09.700,
						42 USC
						1396 d(a), C.F.R. 440.100 and 440.225.
						99-07-023, § 388-535-1050, filed 3/10/99, effective 4/10/99. Statutory
						Authority: Initiative 607, 1995 c 18 2nd sp.s. and 74.08.090. 96-01-006 (Order
						3931), § 388-535-1050, filed 12/6/95, effective
						1/6/96.