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#5 – Manages specialists: Periodontist

Periodontist Coordinator Responsibilities

  • Managing Schedule
  • Knows & uses correct Perio Codes
  • Huddle
  • Runs Perio Maintenance system
  • Scheduling
  • Hamal oral surgery schedule test
  • How to schedule
  • No Show/Cancel System
  • Bone Grafts
  • Implant Billing
  • Medical Insurance billing
  • Financial Arrangements
  • Perio End of Month
  • Perio Schedule Test
  • Halcion

A.    Introduction

Now it is time for you to be the office administrator for a specialist. Manage each specialist for 1 month to get a better feel and understanding of the operations of their practice. When you are done you will be assigned a specialist to manage or co-manage. Good luck!

Checklist for starting a new Specialist Coordinator

  1. Administrator decides which secretary will be the Specialist Coordinator with the specialist’s consent.
  2. Set the training schedule
  3. Call the Specialist to let them know
  4. Administrator meet with the coordinator after 2 weeks to review the level and answer questions.

Steps to train a Specialist Coordinator:

  1. Read through the section for that specialist in detail
  2. The past coordinator to discuss this section page by page with the new coordinator if available
  3. The new coordinator to observe the past coordinator for one day
  4. The new coordinator to work for the Specialist with the past coordinator observing for one day
  5. The new coordinator is now responsible for the Specialist!

Being a Specialist Administrator

Our specialists are highly trained, creative people who are used to working in solo practices.  The challenge for you is to facilitate them to effectively use these talents within the framework of our group to promote the best business results.

As a specialist administrator you have 7 tasks

Task #1: Coordinating the specialist’s energies to fit within our group’s needs

  • Expect your specialist to have a strong personality with definite personal objectives.
  • Spend time observing and learning his/her:   Background, Motivations/Goals, Strengths, How to channel their strengths to promote their and our needs
  • Expect conflicts now and then and learn to handle it to create positive outcomes
  • Expect periodic personality clashes and tension with a push to have their own way at the expense of others.
  • Recognize that pushing for conformity will only antagonize and lead to withdrawal into their shell and disengagement from the group – and taking their good ideas with them.
  • Your success requires you to know how your specialist will react under stress, what personal needs drive their decisions, and how they are comfortable fitting in with their team and the other dentists

Wow! This is not easy! You’ll need the courage to stand up for yourself, the belief that you are okay, doing the right thing, the flexibility to adjust your approach quickly as needs change, and the tact to help them feel they did it.

Ideas to help you succeed:

  • Don’t make unnecessary compromises
  • Develop a staff culture of commitment, trust, respect, and accountability
  • Being able to keep your temp when others lose theirs
  • Manage each person as an individual who has their own strengths, weaknesses, and reasons for working here

Task #2: Understand why your specialist acts the way they do:

  • What are their credentials – where from, how long
  • What were childhood experiences that helped develop personality
  • Type of friends, where live, what do for fun, proudest accomplishments, hobbies
  • Develop a relationship by listening carefully working to develop mutual trust and understanding

Task #3: How can you help them to fit their creative energies and clinical skills into our value system:

  • Develop an environment for your specialist of respect and freedom
  • Avoid  “rules” that limit creativity and freedom to “do their own thing.”  They need to feel they run their own show – some more than others
  • Help them implement new ideas quickly and smoothly.  If they conflict with the group, get with the administrator and owner to discuss confidentially and plan a strategy.  The focus needs to be “how” not get “permission.”
  • Promote a light, fun, environment
  • Stress interdependence with everyone
  • Build trusting, open communications with few secrets and minimal reasons to gossip
  • Stay focused on activities that produce measurable results and then share these statistics with your specialist.

Task #4: Insist on Excellence and Results:

  • Mirror what you expect from your doc and team: Clearly show the visible, measurable results you expect; Be consistent; Provide consistent support; Support growth through the levels
  • Allow conflict, dissenting opinion: Must be for some constructive purpose; Based on fact, not feelings; In a reasonable tone of voice
  • Insist on taking accountability for idea and outcome
  • Set personal standards at least as high for you as others
  • Strong focus on staff career development
  • Develop staff/doc meetings focused on practice improvement

Task #5: Support your specialist to manage staff, build the practice and innovate new concepts

  • Build a strong culture based on our vision, goals, personnel, structure, and actions: Lots of collaborative thinking/dialogue; Rapid sharing of knowledge; Informal, respectful environment
  • Regular meetings promoting all to participate
  • Minimize blame for mistakes: “what did we learn to avoid this outcome when we try again?”
  • Recognize and reward positive results – great and small
  • Use administrator to support your efforts

Task #6: Communicate your organizational structure in such a way that the specialist doesn’t feel controlled by you or our group

  • Clearly define how specialist fits their practice into the group
  • Emphasize how working with our group creates major advantages for your specialist: Increased income; Turnkey clinical care; Solid referrals; Cooperative marketing, etc.

Task #7: Manage effectively while balancing the needs of the specialist and our group

  • Make sure you feel a “can do” attitude – that you are “ok”
  • Work hard to really understand who you are: your strengths, weaknesses and goals
  • Don’t judge good/bad.  Accept the present and plan for the future

Tips on Managing your First Specialist

Reasons docs don’t act when they should:

  • Complex situation causes confusion
  • Tendency to over analyze details delaying decisions
  • So much information from so many sources can’t chose relevant information to make decisions

Practice crises are not caused by:

  • Poor performance
  • Wrong things being done

Instead, they are caused by the old way that led to success no longer works

Administrator’s task to avoid crisis is to have a clear vision of the future that inspires her team to new actions leading to success

  • Narrow the massive information complexity to key, necessary information
  • Have a strategic plan
  • Develop visible measurable goals
  • Focus on most important goals
  • Steer doc clear of intuitive jumps into action that aren’t supported by fact.  Results must be visible and measurable.

Periodontist

Dr. _____________ 

Dr. __________ is a Periodontist.  She provides treatment to patients that have major gum recession and tooth mobility in an attempt to solidify the teeth so that a person can keep their teeth. Often, once gum treatment is completed, the person can have restorative dentistry done with a GP.

She generally performs the following periodontal treatments :

Gum surgery– to treat deep pockets and prevent further bone loss.

Grafts – can be int the form of soft tissue or bone. Recession can be treated with the soft tissue graft and the exposed roots can be covered with the graft.

Crown lengthening – to show more tooth and improve appearance by removing some bone and tissue

She also performs some oral surgery treatment like Wisdom teeth extractions and Other extractions

Your responsibilities as the Periodontist Coordinator include :

  1. Keep her schedule full
  2. Make sure all new clients are scheduled correctly – have referral form filled out
  3. Check in and out clients
  4. If Dr. is running behind seat the next patient and let the Dr. know.
  5. Follow up on all unscheduled treatment patients
  6. Send and follow up on PTEs to schedule patients
  7. Send and follow up on perio maintenance letters-Hygiene and Dr
  8. Schedule lunches with potential referral GPs
  9. Send thank you for referring letters to GPs
  10. Arrange finances for patients
  11. Provide end of month report to Dr. Hamal and Administrator
  12. Coordinate with the GP hygienists regarding STM and perio maintenance patients, and patients with periondontal disease by writing up treatment as done in GP side treatment sheets, notating treatment not yet scheduled on the hygienist pink control sheet for the hygienists to follow-up, and holding quarterly meetings with hygiene and Dr. to discuss successes, failures, protocols, etc.
  13. Run STM success reports and report to Administrator

Managing the Periodontist’s schedule

Day after she works

Review day sheet from last day worked.  Make sure implants are added to Implant spreadsheet, and number of  periodic exams done entered into end of month spreadsheet.  Check daysheet for errors.

Prepare paperwork for biopsies to be sent to the path lab and send through Fed Ex.

Day before she works

  • Confirm schedule – make sure added patients’ charts are pulled and all forms are there.  Check for referral forms.
  • Call in premeds/Halcion for  appointments
  • Make sure patients from hygiene that need Dr. to do their exam are reflected in her schedule
  • Make sure Dr. is the selected provider for all patients and the correct fee schedules are selected in the family file.

Day she works

  • Huddle
  • Check out clients during the day
  • Work on perio unscheduled list, EOM, perio broken appointment list, and perio maintenance tracking
  • Print day sheet and review with Dr. at end of day
  • Prepare letters for patients who are not GP side patients, for Dr. to edit and sign before she leaves (page 35)  At each check-out, scan all consent forms to the patient’s document center, and record treatment done/treatment recommended on the GP side treatment sheet.

Monthly

  • Send perio maintenance letters for Dr. Prepare the hygiene perio maintenance letters for the hygienists to sign and send to their patients who have not yet been scheduled.  Add names of hygiene and Dr  patients to the mailer tracking list
  • Call any patients that do not call us to schedule for perio maintenance
  • Complete end of month report.  Update the implant spreadsheet to track what was used and what needs ordered. Give the completed end of month report to administrator.
  • Records any patients who have had perio treatment and/or implants recommended who have not scheduled treatment on the pink control sheet in clients’ charts so the hygienists have a record of it and can follow-up with the clients the next time the hygienists see them.
  • Assist hygienists with getting their perio maint reminder calls done every month and tracked on their spreadsheet.  Most perio maint patients will be prescheduled 3-4 months in advance to assure they will be able to schedule with Dr. so this list should be short

Keep her schedule full

Dr. works ____________.  With this schedule, it is easy to look at her schedule in Dentrix and follow up on each individual patient. She is willing to come in early to accomodate a patient’s needs – check with her and let her assistant know as the schedule changes.

You can use Dentrix to run a report to find code D0180 (Comprehensive perio evaluation) completed in order to generate a list of patients who have been evaluated and use this list to fill her schedule. Another report you can run is unscheduled treatment for Dr.  – as long as you change the provider in the family file to her name, then you can run this report to find outstanding treatment.  You can also maintain a broken appointment list for Dr. .  You need to send PTEs for clients that want to know what insurance will pay. As the PTEs come back, they will be added to the weekly unscheduled list. Call the patients once they are returned in order to schedule.

You will run perio maintenance letters monthly for Dr. Our insurance/billing person has a signature stamp to send these letters. You are responsible to call these patients that do not schedule from the letter. You may want to create a spreadsheet to track these patients and then you can follow up within 2 weeks. The current spreadsheet is __________.

Adding days to her schedule:

When Dr.’s schedule is full (not including the 4 unit block for new patients and extractions) for four weeks out, please check with her about her availability in adding another day to her schedule.  Once she okays a day, advise the administrator and and make sure her assistant is available to work with her.  If her assistant is working on the GP side, make sure she has coverage for her GP.  Frequently, Dr. will opt to increase her hours to stay into the evenin.  MAKE SURE THIS IS CLEARED WITH HER ASSISTANT !

Making sure patients are scheduled correctly

It is important to make sure there is time in her schedule for new patients and extractions to be seen quickly.  Make sure there is a one hour block in her schedule every week for these appointments.  This block can be deleted and the time made available to other patients two weeks before that date.

Two days in advance, you need to review Dr.’s schedule. Pull the charts and make sure there is a referral form for Dr.  in each one. If they are missing, you need to have the dentist fill one out before her treatment day.

You also need to type info into Dr.’s appointments.  She has remote access, so she will check her schedule throughout the week..

  1. For an exam – update the referral source
  2. For treatment – if the dentrix abbreviation is confusing, type in the treatment being done (so she can bring the correct instruments with her)
  3. For new patients – type in if we have x-rays or will need to take x-rays

Be sure to schedule from top down. For treatment, Dr. and her assistant can tell you how much time is needed.

Huddle            

  1. Huddles are fairly simple. You don’t follow the general practitioner huddle sheet.
  2. Take the schedule on which you made all your notes.  Her assistant will have the charts.
  3. Start with the first patient of the day.
  4. Review the referral form let her know if there are no x-rays
  5. Make sure Dr. and assistant are aware if charting, pictures or a narrative will be needed for insurance.
  6. The charts stay with the assistant when the huddle is done

Periodontal Huddle: 15 minutes before first patient scheduled

Did everyone clock in?

Review today’s schedule

a)      Any past client problems?- upset, long wait, etc.

b)     Care to share cards to give out?

c)      How many periodic exams will Dr need to do today, and for whom?

d)     Do we have lab cases that we are seating?

e)      Anyone to ask for a video testimonial?

f)      Anyone that will make a good blog story?

g)     Do you have all your pamphlets in the charts for today’s treatment?

h)     New patients not referred by the GP side: review who referred, what the concern is, X-rays needed?

i)       Any perio maint patients that should meet a hygienist to have future recall out of Dr’s schedule?

 

Secretary: holes in upcoming two weeks of appointments that need to fill?

Insurance narratives needed?

Other projects that Dr. needs to complete today (videos, photos, etc)?

Charts in Dr’s bin that need follow-up or consultation with other doctors?

 

Checking in and out patients

Be sure to get a copy of their dental insurance card for the chart & confirm the information in the computer is correct.  For biopsys or treatment resulting from an accident also get a copy of the medical insurance.  Collect payments, set Financial arrangements, and manage contracts same as the GP side financial policy for appointments today and future appointments.

To manage the perio maintenance system for our Periodontist:

On a monthly basis, print the perio maintenance letters for our Periodontist and GP side hygienists.  When patients call to schedule their “cleaning” (as written in the letter), the secretary must check the family file in the computer to make sure they are following the continuing care. These patients should be scheduled for 3 units with our Peridontist with code D4910.1 (Perio maintenance by specialist) or 4 units with a hygienist when our Periodontist is here with code D4910 (perio maintenance).  There should be a periodic exam scheduled, as well.  If the exam is not needed, the assistant or hygienist will remove it before setting the appointment complete.  Dr.’s assistant will add an alert to all of Dr.’s STM’s and certain surgeries that need to be seen for perio maintenance and she will change their continuing care to Dr.’s perio maintenance code and write perio maintenance on the blue treatment sheet.

To run the perio maintenance letters:

  1. Go to the office manager
  2. Click on letters – cont care – Perio Maint Recall Periodontist or Perio Maint Recall Hygs
  3. Click Edit
  4. The Cont. Care line should say either Perio – Periodontist or Perio Hyg.  Click on the arrows to the right of the cont care line to edit the dates for which you are sending the letters.
  5. Click OK to get out of the edit screen.
  6. Click Create/Merge.  Make sure Create Date File and Merge Letters, and Add to Journal are selected.
  7. Hit okay.  The letters will create and will pop up as Word documents
  8. Scan through the letters for any editing and make any changes (remove symbols like *, ^, etc)
  9. Be sure to save the letters using Save As.  They are saved under ______.
  10. Once saved, you can print the letters.
  11. Go the recall tracking sheet and add the names of the patients for whom you have a letter to the correct spreadsheet.  The hygiene patients are recorded by hygienist.  Record the date you are sending the letters, the number of letters for each hygienist, and the patient names.  For Dr , just record the date, and the name of the patients.
  12. Check each patient for whom a letter has printed for an appointment already scheduled.  If they have an appointment date in the tracking spreadsheet.  If they do not have an appointment already scheduled, separate them into stacks for each hygienist to sign.  For Dr.  patients, use the signature stamp to mail the letters.
  13. Print a copy of the hygiene spreadsheet updated for the hygienists and put in the hygiene bin.  Print a copy of both the hygiene and Periodontist spreadsheets for yourself, if you wish.  You will use these sheets to contact patients throughout the month to make sure they get their appointments scheduled.

Scheduling for our Periodontist

To schedule a new perio patient:

  • Code : D0180 (Comprehensive perio eval) – Perio category
  • Time : 2 units
  • Fee : $98
  • X-rays : Have the patient bring their CMX if they have one. If they do not have one, then we can take a CMX for them.  Make sure you have a referral form

To schedule a new oral surgery patient:

To schedule exam only:

  • Who: For wisdom teeth, multiple teeth extractions, or patients with health issues
  • Code: Oral Surg – Specialty Exam alone 00150.1
  • Time: 2 units.
  • Fee: $78
  • X-rays: Pano needed (can be taken at appt)
  • Make notes in the appointment if panoramic x-ray available, what treatment is needed and referral source.

If not seen by an internal GP, you must ask the following questions: “Let me get some health information from you so the doctor can know what to expect”

  1. Do you have any medical problems?
  2. Do you have any chronic health problems?
  3. Are you under the care of a physician?
  4. Are you currently taking any medication? (Daily aspirin/blood thinners-physician may need to know about?  Insulin (for diabetes) requires physician consult?  Asthma inhaler-bring to appointment)
  5. Do you prefer IV or oral anesthetic?
  6. Do you have current x-rays?
  7. How were you referred?

Our Periodontist is a member of the following insurance plans: 

Make sure you have a referral form for all new patients. 

To schedule surgery rechecks :

Dr. requires a 1unit no charge After Surgery Recheck (Code D7900) one to two weeks following either gum or oral surgery. These appointments should be scheduled in Dr. RCHK column at the start or end of an appointment in her column. Do not schedule these in the middle of a surgery as she is not able to break from surgery.

Perio maintenance Specialist: Time 3 units and Code : D4910.1

Perio scaling and root planing :

For 1-3 teeth, code D4342  Time : 2u

For a quadrant, code 4341   Time : 3u

Gingivectomy : (Remove excess gum tissue, no hard tissue is involved. Can be just one tooth or multiple teeth.)

Per tooth, code D4211  Time : 2u

Per quadrant, code 4210  Time : 3u

Gingival flap : (Resecting the gums and getting access to the roots of the teeth.)

For 1-3 teeth, code 4241  Time : 3u

For a quadrant, code 4240  Time 5-6u

Crown lengthening – Code 4249  Time – usually 4u per tooth

Surgical procedure where more of the tooth is exposed – there are 2 types of crown lengthening :

  1. Cosmetic – When the teeth are small and more gums are showing than the patient thinks looks good. Normally, insurance does not pay for this procedure if the only reason is for appearance.
  2. Restorative purpose – When the crown margin is below the gum level or a cavity extends below the bone level and good margin is not accessible to the GP dentist doing the crown 

Bone graft – Time : 4u

Code 4263 and 4264 (additional sites)

She usually uses synthetic bone graft material, but occasionally will be autogenous (taken from other parts of the mouth from the same patient) or bovine.

Bone grafts are done when a patient has bone loss or a bone defect around the root.

Bone grafts are generally charged out at the same time as a gingival flap surgery.

Soft Tissue graft – Time : 3u

There are 3 types :

  1. Connective tissue graft – Code 4273
  2. Free gingival graft – Code 4271
  3. Double papillary graft – Code 427

Distal wedge  Code 4274   Time 4u

This is the surgical elimination of pocket or bony defect on the distal of the last standing tooth.

Biopsy   Time 2u

Dr. only does soft tissue biopsy (not hard tissue). This is removal of an oral lesion for pathological examination.

Extractions – Single tooth, simple 2u

All wisdom teeth 4u.  If any impacted, then 4-5u

Frenectomy  Code 7960  Time 2u

Surgical exposure of impacted tooth for orthodontic purposes – Code 7281 Time 3-4u

Other Codes Used :

Periodic Exam : D0120 – used when a patient is in for a cleaning and gets an evaluation by a dentist

Look see D4900 – a 1 minute intro to our Periodontist. She does a quick look and decides if she wants the patient to return for a comprehensive perio evaluation.  Next step is either a D0180 (Comp Perio Eval) or D0150 (implant exam)

Comprehensive Perio Eval : D0180 – takes 30 minutes

Prescriptions

Dr. will prescribe Halcion as an oral sedative.  We have a form Dr. will fill out with the prescription information (at end of this section).  The prescription is to be called in two days prior to the appointment.  The patient will need someone to drive them to and from the appointment.

 

Patient Questions for Oral Surgery

Ask patient if they would like to have

  1. Local anesthesia
  2. Nitrous oxide
  3. Halcion (follow procedure in Assistant Level 2)

If patient has medical problems

  1. Ask patient if there are any medical problems we need to know about
  2. Any chronic health problems
  3. Currently under the care of a physician for any condition
  4. Currently taking any medications (including an aspirin a day)

If patient has any of these medical problems, they will require a consultation with Dr. Hamal and a medical clearance from their physician.

Aspirin or Blood Thinners – cause bleeding during surgery

If they are taking Aspirin or a blood thinner (Coumadin), the patient needs to consult their physician to see if they can be taken off their medication for a period of time. Their doctor must advise them. NOT US. The first sign should be – any heart problems. We will always do a medical clearance for this type of medical concern.

Insulin (for Diabetes)

If patient is diabetic and is taking insulin, we need to consult their physician for them to adjust their insulin. We will do a medical clearance.   Diet controlled diabetic – usually okay.

Inhalers (for Asthma)

If patient has inhaler, must bring it to their appointment.

If patient calls complaining of having a cold, make sure they can breathe through their nose.

If patient has Bronchitis, their appointment will need to be rescheduled.

 

To schedule for our Periodontist in Dentrix:

  1. Locate a date and time for the patient-in the second column for any treatment or exams, and in the third column for rechecks.
  2. Select patient name
  3. Go to the tooth chart, select the teeth/quadnrants for treatment, and the correct treatment to be done.
  4. Schedule in the appt book using the treatment plan you’ve created.
  5. Select the length of the appointment
  6. Click the staff button and select your name (to show who made the appointment)
  7. Click ok
  8. Add notes to the appt so they will print on the schedule
  9. Confirm patient Insurance coverage
  10. For extractions or biopsy patients that have not yet seen Dr. please schedule the treatment and a specialty exam with treatment (located under oral surgery)

When scheduling, please advise patients the comp perio or specialty exam may not be covered by insurance. Most insurance plans will only allow 2 exams per year. They may want to confirm coverage with their carrier should this be an issue.  

No Shows / Cancellation Procedures

                                                                   No Shows

If a patient no shows you will need to no show in the computer and make a note in patients chart.When you call them, please follow the GP side no show policy.  When rescheduling patients to whom you have given the no show/cancel speech, make a note in the chart that you gave them a no show speech and add procedure D9923 (discussed missed appts personally) to their ledger, same as with GP patients.

Cancellations

If someone cancels an appointment more than 24 hours in advance, you can reschedule at this time.

If appointment is canceled less than 24 hours, they will go on broken appointment list, same as GP patients.

Once on the broken appointment list, you can call the client to reschedule 3 times.  After 3 attempts, note in clinical notes that we attempted to call and take them off the list.

Insurance Estimates and claims

Periodontal – Need perio charting, pictures, X-rays and narratives for insurance and estimates.

We estimate 50% coverage on all treatment – be sure to check the family file, insurance box, payment table to see if we have any experience with this insurance company for the codes you are planning to use. If we do, then you can feel more confident that insurance will pay accordingly. If we do not, then make sure to change the insurance coverage to 50% in Dentrix. If the patient is very concerned that they know exactly what insurance will pay, we can send a PTE. This usually takes 3-5 weeks to get back from the insurance company.

Once treatment is completed and the e-claim has been sent to insurance, Dr. may need to write a narrative for quicker processing by the insurance.  Our insurance person will let you know when narratives are needed for claims or estimates. Dental insurance companies do not play nicely with periodontics ; they require x-rays and narratives to prove treatment was necessary – same applies for PTEs.

If you have coding questions refer to secretary level 4 – Maximum benefits for clients

Get a copy of the medical insurance card for patients having their wisdom teeth extracted and for biopsies.

Create your estimate for the patient based on the dental insurance coverage only. The patient has to pay any amount not covered by their dental insurance (even if they think medical insurance might help pay for some of their personal amount). Explain to the client that we will submit to their medical insurance only as a courtesy and their medical insurance will send reimbursment to the patient if they will cover any of the treatment costs.

 

PERIODONTAL – BONE GRAFTS

There are basically 3 reasons to perform a bone graft that dental insurance may cover:

  • Replace bone destroyed by periodontal disease, trauma, or ill-fitting dentures.  We use code D4263 bone graft first site and D4264 bone graft additional sites.  The ADA describes these codes as:  A bone graft placed to stimulate periodontal regeneration when the disease process has led to a deformity of the bone.  The tooth number for each site must be indicated on the claim form.  The dental insurance companies will request a narrative on the diagnosis and treatment along with x-rays and periodontal charting.
  • Increase the amount of bone in the sinus area for implant placement. The ADA code for the sinus lift is D7950 and is described as: A bone graft placed to augment the sinus cavity to increase the alveolar height for reconstruction of edentulous portions of the maxilla. The area (quad) must be indicated on the claim form.  The dental insurance companies will request a narrative on the diagnosis and treatment along with x-rays and periodontal charting.
  • Preserve bone levels in an extraction site for future implant placement or to eliminate the need for an elongated pontic for a partial.  The ADA code for ridge augmentation is D7950 (the same as for sinus lift) and is described as:  A bone graft placed to increase the height, width and or volume of the residual alveolar ridge.  The tooth number must be indicated on the claim form.  The dental insurance companies will request a narrative on the diagnosis and treatment along with x-rays and periodontal charting.

IMPLANT BILLING

There are 42 implant codes available through the ADA for submitting to dental insurance companies.  We do not use that many! The ones we use (or could use) have been grouped into categories for better understanding:

  1. Pre-surgical services
    1. D0150.5 – Implant exam
    2. D0330 – Panoramic x-ray
    3. D0470 – Diagnostic casts/wax-ups
    4. D6190 – Surgical Guide
  2. Surgical services
    1. D6010 – surgical placement of implant body
    2. D6100 – implant removal
  3. Implant supported prosthetics
    1. Supporting Structures
  1. D6056 – prefabricated abutment – includes placement
  2. D6057 – custom abutment – includes placement
  3. D6053 – for completely edentulous arch
  4. D6054 – for partially edentulous arch
  5. Both of these codes are used for removable overdentures that are supported by implants.
  6. D6059 – abutment supported porcelain crown
    1. Implant/Abutment supported removable dentures
    1. Single Crowns, Abutment supported
    1. Transitional Removable Appliance

1.   D5820 – interim (temp) partial denture – upper

2.   D5821 – interim (temp) partial denture – lower

3.   This code is used when a front tooth (smile area) has been extracted and the area needs healing time.

Medical Insurance Billing – Implants and Bone Grafts

Typically, medical insurance companies will cover implants and bone grafts in case of trauma; however, the documentation must clearly show the medical necessity. Some of the medical insurance companies are beginning to cover implants not due to trauma but due to atrophy, congenital tooth lose, etc.

When medically necessary, replacement of teeth by dental implants is covered by the medical insurance company; however, the only procedure covered is the surgical placement of the dental implant body (replacement of the missing root) – our code D6010 for the root form implant.  The restorative procedure (replacement of the missing crown) is considered a dental expense and is our codes D6056 for the abutment and D6059 for the implant crown.

There are situations that will allow the medical insurance to be billed for an implant when a bone graft is necessary.  These are atrophy, congenital or traumatic loss of teeth, nerve pain due to denture pressure, and chronic mouth sores (stomatitis).

The Medical Cross-Coding Binder will list the ICD-9 diagnostic codes such as:

525.21 minimal atrophy of the mandible

525.25 moderate atrophy of the maxilla

and the CPT codes such as :  21248 reconstruction of mandible or maxilla, endosteal implant, partial

These medical codes (and similar ones) would be used when the medical necessity is indicated on the treatment sheet by the dentist.

Medical claims are not sent electronically.  They must be completed on paper (blank forms are located in Jamie’s office).

Preparing Biopsy Forms and Sending to path lab.

Dr. performs soft tissue biopsies only. She will place the specimen in a specimen jar, which is then placed in a plastic biohazard bag.

Dr. will fill out the clinical section of the biopsy form that comes with the specimen jars.  You need to fill out the patient information on this form, including a copy of the medical insurance card for the path lab to use for their billing,  The copy of the medical insurance card can be cut out and glued to the form, to save copying it over.

Scan the completed biospy form (as all other documents are scanned – if you need a reminder, the instructions for the scanner are in secretary level one) to the patient’s document center.  Roll the completed biopy form along with a blank sheet of paper around the specimen jar, place everything in the plastic biohazard bag, and place the bag inside a FedEx envelope.  The University Path Lab provides pre-labeled Fed Ex shipping labels to be attached to the outside of the envelope.  Please call Fed Ex at 1-800-GOFEDEX and follow the prompts to arrange for pick-up of the package. Our  account number withFed Ex is ______.

Shipping materials are kept __________.  The pre-labeled FedEx shipping labels are kept ___________.  When you are running low on these supplies, please call the path lab at the number on the Fed Ex labels, or include a note with a sample being sent.

The path lab will generally fax results to our office within 5-7 days.  A hard copy of the results will follow within a couple days.  Read through the results and, if any mention of malignancy is included in the write-up, please forward the faxed copy to Dr. immediately.  She may wish to follow-up with the patient before their scheduled re-check, or provide additional instructions to you or her assistant.

Consent forms

Dr. has a consent form for all her treatment. These consent forms are given to the client by the assistant at the beginning of their treatment appointment for them to review and sign.

Treatment Brochures:

Brochures for perio treatment, extractions, implants, and any other treatment Dr. recommends to the patient during her exams should be given to the patient by Dr’s assistant during the exam appointment.  This gives the patient the information regarding their treatment,so they can make an informed decision, and can explain to family members what they are having done.  The referral sheets are reviewed during huddles for all exams, so her assistant can make sure the correct brochures are already in place in the chart.  Dr.’s assistant will make sure she has a stock of commonly used brochures in Dr.’s bin.  Please pop-quiz patients as they are leaving to assure they are getting their brochures.  For periodic exams, the hygienist is responsible for getting the brochure to their patients.

Financial arrangements

Our periodontist follows the GP side guidelines for collections.

At end of day – print a day sheet for Dr. review it for accuracy and give it to her (Office manager, Day sheet icon, Select provider , today’s date and ok then print from the office manager list).

Small cases $250 and under – to be paid in full

Large cases $250 and over – ½ down to schedule, balance due the day of appointment, or offer CareCredit

Rechecks have no charge – unless outstanding balance

Insurance

We need a copy of both the medical and dental insurance card for biopsy patients.

You will need to change the provider of record (in the family file) to Dr. before you send insurance claims or PTEs.  This should be checked a day or two before Dr is in to make sure the correct provider and fee schedules have been selected. After the insurance claim is printed (or sent as an Eclaim), you can change the provider back to the original.

Medical insurance –These claims need to be printed to paper upon creating the claim. Our insurance person will take care of sending these claims for you. She will copy to the medical HCFA form.

Must pay their estimated portion their insurance will not cover, and their deductible.

 

Charge outs

Upon checking the patient out, give the chart back to Dr to review.  She does clinical notes, although will occasionally makes notes in chart as well.  Make sure you have scanned the consent forms to the patient’s document center.  For treatment done for GP side patients, notate what was done (Example: Patient saw Dr Hamal on June 1 for gingival flap LL and UL quads.  Next visit: Recheck on June 14)

 

End of Day

Before Dr. leaves, print her day sheet.  Have her review her charts for accuracy and sign letters being sent to referring doctors.  Make sure she has signed any letters, signed refund checks and completed any narratives for insurance.

To prepare a letter for a referring doctor outside of our office, you can use the template ________.  Locate the correct information for the patient’s GP.  The patient may know this information, or you may have to look it up through Google or whitepages.com.

Generally, you can use Dr.’s notes in the chart or clinical notes, as well as the perio charting in the patient’s tooth chart to write the letter.  Make note in the letter as to probing depths, whether there is keratinized gingival, recession, bleeding, oral hygiene, recommended treatment, accepted treatment, next visit, and recommended follow-up.

Dr. will review the information you have provided, and make any corrections for you to type before signing.  If the corrections or additions are lengthy enough to have to be finished the next day you work, there is a signature stamp that you can use.  Send the letter, as well as additional referral brochures, to the referring dentist.

Save the letter.  Additional letters sent for each patient through-out the year can saved the same with the month added to the path.

For GP side patients, you do not need to prepare a formal letter.  Write up the visit with Dr. in the clinical notes:

  • For evaluations/exams: Pt saw Dr. _____ on (date) for (type of exam).  Recommended treatment is: (treatment),
  • NV: (treatment) on (date).  Include your initials
  • For treatment: Basically the same write-up as above.  Pt saw Dr. _____ on (date) for (treatment).  NV: (treatment                 or reason for next visit such as recheck) on (date).  Include your initials.

End of month reporting

Dr. Hamal’s production goal is $______/year which is $_____/month and $______/week.

Dr. has a production goal and bonus system set up for her coordinator and assistant.

You are responsible for filling out an end of month report – give one copy to Dr. and one to the administrator – using the following End of Month instructions.

Specialists End of Month

Start by creating new excel worksheet for case acceptance that month

To find patients, run the following report for code D0180 (perio consult) :

  1. Office manager, letters, Misc tab – highlight the letter that says “Stats Perio Case Acceptance” and click Edit
  2. Select Edit – the defaults are all correct, they are:
  3. Now click OK again to close this window also.
  4. Click on Create/Merge – Select “Create data file Only” – click OK
  5. Now it counts – you can watch the numbers as it looks for the patients who have a continuing care appointment in that month. This takes a few minutes since it has to look at each patient in the system.
  6. Once the report is finished (the window showing the counting will disappear), then click View List – this will bring up your results in a window.
  7. In the window, choose Edit – Select all and then Edit – Copy
  8. Now, open Excel and click Edit – Paste under Comprensive Perio Exam
  9. **Now, repeat for code D0150.5 and paste under Implants
  10. Count the total number of new patients (not patients already established as HP patients) – enter this number on your end of month report.
  11. For any clients who have recommended implants and/or perio surgery and HAVE NOT SCHEDULED, pull their charts and note on the hygiene pink control sheet what the recommended surgery is.  This will give the hygienists a heads up so they can continue to talk about it with the patients at recall appointments.
  1. Patient name: A – Z
  2. All providers
  3. Checkmark the patient box
  4. Uncheck all gender, position & balance aging boxes
  5. Do not check the “Guarantors only” box
  6. Billing type 1-4, 11-14
  7. Clear all the fields (starting with appointments and ending with zip codes)
  8. Click the button next to Procedures – this brings up a window “Select procedure range”
  9. Checkmark the Completed box
  10. Enter D0180 in the Beginning and Ending boxes
  11. Enter the month in the Beginning and Ending date boxes (for example 1/1/09 – 1/31/09)
  12. Click okay to close the window

Scheduling Test:

  1. Schedule a fake patient for surgical extraction of #15 and bone graft (1&4)
  2. Schedule a fake patient for connective tissue grafts #6,7,8,9 (1&5)
  3. Schedule a fake patient for surgical biopsy (1&2)
  4. Schedule a fake patient for gingival flap UR quadrant and #30 area (1&4)
  5. Schedule a fake patient for post-surgical recheck
  6. Schedule a fake patient for osseous surgery #2, #31 (1&3)
  7. Schedule a fake patient for scaling and root planning all quads and occlusal adjustment (1&6)
  8. Schedule a fake patient for 8 week re-evaluation of therapy and reprobe (2u)
  9. Schedule a fake patient for extractions of complete impacted thirds with Halcion(4&4)

Halcion Form:

Patient Name: ______________________ Age___________    Weight _____________

Procedure sedation:

RX: Halcion

Dosage:            c        0.125 mg

c        0.25 mg

 

Dispense: 3 tablets

Direction: Take 1 tablet ½ hour before bedtime the night before the appointment.

Bring the other two tablets to your appointment.

Pre surgical check list

 

Pre-surgical Post-Surgical
Escort  Stable BP
Signed Consent Fully responsive and Conscious
Took any premedication Post op instruction given to escort

Contraindications:

Hypersensitivity to triazolam or Benzodiazepam

Pregnancy

Patient on Ketoconazole/itraconazole, nefazodone and ritonavir

____________________________________     ________________

Dental specialist                                                    Date

_____________________________________    _______________

Team leader                                                            Date