#1 – Advanced Scheduling

This section includes information on scheduling all our specialists.   You need to scan all the information in this section to become familiar with each specialty.

 

A.  Pediatrics

Get to know the pediatric dentists and staff

Enjoys helping fearful and apprehensive patients and parents through complex dental appointments.

 

There are several advantages to scheduling with a Pediatric Dentist

Pediatric Dentists receive 2 additional years of specialized training on working with children over General Dentists – this training includes voice control, how to complete treatment very quickly and specialized clinical training on working with baby teeth

Dr. offers selected Saturdays 8am – 1pm and selected Monday evenings 12 noon– 7pm to be convenient for his clients.

Dr. provides a written warranty for his clients – he will repair or replace any filling or crown within 3 years of its placement as long as the child returns to her for regular dental cleanings.

Dr. achieves 92% decay free for children that come to him for regular dental cleanings – the national benchmark is 50%

Dr. provides early orthodontic treatment for children as young as age 6.  If any treatment is needed and the child is apprehensive at all, most GPs will not see these kids until they are at least 13 years old and can handle themselves.

Dr. provides treatment using nitrous oxide, oral sedation or IV sedation so no one is turned away. Dr. will have anywhere from 2-5 columns of patients when they are in our office.

 

There are a couple of extra things to remember when scheduling for the pediatric specialists.

•           Children under the age of 7 should be scheduled in the morning for treatment because they tend to get grumpy around naptime (in the afternoon) No exceptions. Cleanings may be scheduled anytime.

•           Many times patients are referred to Dr. by general dentists because of their special skills with children.  If this is the case, schedule 3u new patient kids exam with the doc or an EFDA.  They’ve probably already had a cleaning and exam by their referring doctor and we need only to evaluate and treat the patient’s cavities.  This time is also used for Dr. to get to know the patient and see how they will react to treatment.

•           Don’t ever schedule treatment with Dr. if they’ve not seen the patient themselves.  Always review the chart with the doctor before putting the patient in their schedule.  They may need to get the child back in the for a re-check appointment before scheduling treatment so that they can asses whether or not the child will need to be sedated.

•           Only schedule treatment and comprehensive exams in Dr. schedule.

 

1.  Scheduling Treatment and Re-care appointments:

The pediatric specialists do treatment and cleanings differently.  The most apparent difference is between a child cleaning and an adult cleaning.  Children normally do not have enough build-up on their teeth to require a hygienist go in and scale the build-up off of their teeth.  Normally the children come in and one of the assistants goes over brushing and flossing and good nutrition with the children. Then the doctor comes in and looks at or “counts” the child’s teeth before doing a thorough polishing with a prophy brush.  If for some reason they don’t do a polish, we still charge for the PC or preventive care portion of the appointment and discount the charge by $10.

Another thing to keep in mind is that the timing is different for re-care appointments.  Be sure to schedule 3 units for each prophy.  If you are scheduling sibs together there should be 3 units for the first child 2 units for each additional child.

Treatment should always be scheduled as 1 unit anes and 4 units doc time.   Remember that the EFDAs get credit for placing all fillings, sealants, PC’s and emergency exams.

Be sure that you do not schedule a patient’s entire appointment during the time that Dr. is doing Oral Sedations.  This is the only type of sedation that is done when regular patients are in the office.  The doctor needs to give the patient an hour of uninterrupted time and will have to reschedule any patient that is scheduled completely during the sedation time.  If a cleaning is scheduled with 1 unit of the appointment before or after the hour of sedation, this is fine.  This allows the doc to go in and check before or after the sedation and keeps the schedule running smoothly.  See the sedation section for more information on Oral Sedation.

 

2.  Sedation Options

Dr. does three types of sedation appointments.  These are usually costly and require special care when scheduling and dealing with the parents.  Be sure to use the checklists.  The checklists have been created to keep everyone on the same page with sedation patients.  They help maintain consistency and help us to avoid mistakes as well as angry and frustrated parents.  These are invaluable.

The second thing you’ll have to remember is adding the appropriate sedation fee.  These are in the system under “Other”.  You have an Oral sedation code, a “Tx Coordination fee” for ambulatory/IV sedation, and a “Hospital Surgery fee”.  These fees are not normally covered by insurance and are Dr. fee for doing the procedure.  They help to cover the additional staff, risk, and special time that are dedicated to the child being sedated.  Most parents don’t question this, some may.  Remember to send a PTE for all sedation cases as soon as possible.  This information is very important and will avoid collection issues.

Being aware of advanced treatment (IV sedation & hospital cases)

Read all the handouts for pediatric dentistry – be prepared to answer basic family questions about them. Dr. Devany comes to our office and puts the child under sedation using an IV.  In addition to the dental fees we collect the money for the anesthesiologist also. They require $400 deposit to set up the appointment; this covers the first half-hour of treatment.  There is a fee of $700 for the first hour (which the deposit is applied to, so parents will actually have a fee of $300 for the first hour).  There is an additional fee of $75 for each 15-minute increment of time after the first hour.  The remainder of the money is collected at the end of their actual appointment.  Be sure to explain these charges are in addition to Dr. charges.  Our pediatric coordinator can supply parents with the proper forms to submit to their medical insurance because the medical insurance may reimburse them for a portion of the anesthesia charges.

Oral sedation  “sleepy juice” This is liquid Demerol (Dr. uses Oral Versed) that will relax the child and make him more agreeable to treatment.  The charge for Oral Sedation is $251.  If the treatment is done in more than one visit, there is an additional Oral Sedation charge. This type of sedation does not put the child to sleep.

As with all appointments with a $250 patient portion (or over), 2/3rds of their portion for treatment is due before scheduling, or pay in full to schedule and receive same cash discounts (unless they are Managed Care patients).

To schedule an oral sedation, these are done first thing in the morning and the child is not to have anything to eat or drink after midnight the night before. This is also called NPO for short.  The first unit in Dr. schedule is blocked to give the child the “sleepy juice”. Remember not to schedule other patient’s during Tx (pay attention to the blocks) Dr. needs 1 hr block time when column as well as the assistants.  His medicine only takes 15 minutes to start working.

IV sedation or Ambulatory is when a child is sedated (sleeping) completely.  Dr. Viola Devany, MD is a board certified pediatrician who is also licensed to do anesthesia.  She assists with these cases in our office.  Dr. Devany has 12 years hospital experience with both adults and children.

The first step in scheduling an ambulatory patient is to have the parent(s) or guardian(s) come in for a consultation appointment.  You’ll schedule two units with Dr. and then two units with a secretary.  A formal treatment plan and paperwork will need to be put together for this appointment.  See the “Preparing a Pedo Treatment Plan” section for further information.  There is a strict pre-pay policy for Ambulatory patients.  They need to pay for at least 2/3rds of the treatment and $400 of the anesthesia to schedule the appointment and then the remainder will be due the day of the appointment. Be sure that you have firm financial arrangements and take good notes to prevent problems in the future.  Follow the checklist!! If they pay in full they also receive cash discount (unless they are Managed Care).

The third type of sedation is General Anesthesia at Dayton Children’s Medical Center.  Normally this is done when a child is too young or has a medical history or condition that does not make it safe to do the treatment in our office.  Sometimes it is also the case that a parent will request that the procedure be done in the hospital simply for peace of mind. Dr. will do the treatment. You will add a hospital fee of $536 to the treatment plan.  Not covered by dental, possibly by medical.

The financial arrangements are different for hospital cases.  Because the treatment is done at Children’s, the parents don’t come to our office to check out.  Therefore, they need to pay in full to schedule.  I wouldn’t recommend scheduling until you have the payment from the parents.  Dr. Mason prefers that we schedule more than one case at CMC if possible.  If it’s not possible though, it is okay to go ahead and schedule one case.  Fill out one of CMC surgery scheduling forms on the patient fax it to the surgery scheduling department.  They will send you another fax usually within 24 hours to confirm the time.  Make sure you note the confirmation number.  Also make sure you let the parents know they’ll need to arrive at CMC two hours prior to the appointed time.

Let the parents know they must contact their medical insurance to verify approval of hospital and room charges that will be billed from Children’s.  Children’s will ask for an approval number from their medical insurance when the appointment is made.  We call children’s scheduling department and set up the appointment with them.  Children’s will fax a confirmation sheet to you.

Let them know nothing to eat or drink after midnight the night before the appointment.  They will go over anesthesiologist fees and give them information on medical insurance to pay.  We will make necessary financial arrangements and schedule the appointment.

 

Patient Follow – up

This is pretty self- explanatory. You’ll need to make sure on a daily basis that you are making notes of who you talked to and note in your calendar that you need to follow up with.  Parents will call upset if they don’t hear back from you and you don’t want that.

Oral Sedation Blocks

Because of the way that the pediatric dentists schedule their sedations you’ll want to make blocks in the schedule holding future sedation time from 9:30-10:30.  Dr. starts Tx @ 9:45.  Block 9:30-10:30 in the other columns due to Dr. needing his assistants.  Do these at least six weeks in advance to cover the schedule.  See “Oral Sedation” for more information.

 

Understanding their Appointment Schedule (F6 page)            (The first 2 columns are treatment)

1)         1st column Tx only for Dr.

2)         2nd column Tx only for Dr. (sealants can be in 2nd column)

3)         3rd column Bonny/Mallory–

4)         NP exams – 3 units

5)         Sealants – 4 units         (First 2 columns)

6)         PC’s -3 U for all PC’s (exception 2 or more sibs put in same column 1st sib 3u2nd 2u) (In the same column)

7)         Re-check’s in – RECK – column 2 units (unless seating space maintainer) (1st column if seating spacer) (if open time put in assts column)

8)         Treatment – 1 unit anes, 4 unit doc

9)         Children under 6 years old, schedule before 1:00 pm for treatment (emergencies, check teeth and NP exams can be scheduled anytime for all ages)

10)       Do / 50.3 under diagnostic (Comp. Exams) NP exams – 3 units (other doctor referrals re defined as NP exams and go in Dr. or EFDA column only)   (any column)

11)       All other NP’s begin as PC (refer to #5) unless they are a NPCKT / Emergency exam

 

Pediatric Scheduling Test

Now, open the Dentrix appointment book and find an empty day that has all the appropriate blocks. Schedule the following pediatric appointments.

To look up these names, type “AA” and arrow down to the right person.

A         Nat AA Brooks – Mom calls in and says they have been referred by GP Dr.

B.        Lindsey AA Jones – Mom calls in and says she has a toothache.

C.        Teresa AA Caudill – Dad calls and says they are new to the area and need a first visit.

D.        Chuck AA Smith – Mom says Chuck is 3 years old and has never been to the dentist.

E.         John AA Gennantonio – Mom says he is 8 years old and has never been to the dentist.

F.         Hady AA Saleh – Dad says Hady is 2 years old and needs to schedule his checkup.

G.        Loraine AA Smith – Mom says Loraine is 10 years old and needs to schedule her checkup.

H.        Laura AA Woods – Mom calls to schedule treatment (DO Amalgam on A and DO Amalgam on B) – 4u in EFD2 column (Dr. ) or 1st column (Dr. )

I.          Rupa AA Hamal – Mom wants to schedule sealants on 14, 15 & salmon sheet shows 3u needed.

J.         Keith AA Campbell – Dad calls in and says Dr. GP has referred them.

K.        Peggy AA Gennantonio – Mom calls to schedule treatment (pulpotomy & SSC on K) & salmon sheet shows 3u doc

 

Schedule these appointments, then print your schedule & review it with the pediatric coordinator.

___________________________________

 

Pediatric Coordinator signature – I have thoroughly trained & am confident of her ability to accurately schedule pediatric patients.

________________________________________________

 

 

 

B.  Orthodontics

Dr. is an Orthodontist. He provides braces and appliances to correct crooked teeth and jaw position for kids as young as 9 up to adults. He brings his own assistants and works on Fridays 8-5 and the 1st & 3rd Wednesday of each month 8-5.

You are responsible for the following:

1.         Entering new patients – whether referred by HealthPark or from outside HealthPark

2.         Scheduling all ortho treatment and visits

3.         Get to know the orthodontist and staff

4.         Fill the schedule

5.         Support the specialist coordinator with her projects – including preparing treatment plans, sending letters, scheduling lunches, etc.

 

Entering new patients

A.  For the orthodontic patients, even if they are already patients at HealthPark, we enter them again, so their orthodontic accounts only have ortho information in them.  For the patient named Ann Carter, her ortho account would be entered as Ann zz Carter.  Place two z’s at the beginning of the last name, enter a space, and then the name: zz Carter.  This keeps all the ortho accounts together at the end of the database.  We have separate ortho accounts since we charge their entire fee for their ortho treatment up front, and since we use the FIFO (first in first out, meaning first charge in will be paid first), method of accounting, we can’t wait until their 3500.00 ortho treatment is paid before their cleanings and restorations and other treatment.    Also, each ortho account can only have one patient in it.  (The reason for this:  Dentrix only allows one payment agreement per account.)  So if Ann Carter and her sister Jane are both going to have treatment, they each would be entered on separate accounts w/ whoever is responsible for the account on each account as the guarantor.  For example if Ann and Jane’s dad is Joseph Carter you would enter zz Carter as the last name, then “Joseph for Ann” as the first name on the account where you are putting Ann, and likewise “Joseph for Jane” on the account where you are putting Jane.  This way when we are entering payments under the guarantor names, it is easy to see which is which.  If Joseph Carter would then decide to also have ortho treatment, he would go on a third account and his first name would be “Joseph for self”.

 

B. Select if this is a patient, non-patient (for example a parent of an orthodontic patient) or inactive. Select male or female. Select Married, Single or Child.

C. Birth Date   Enter numbers in MMDDYY (month, day, and year) format (e.g. July 2, 1964 would be entered as 070264.  The day and year always require two digits, such as 07 and 02.

D. Soc/Sec/No   Enter the 9-digit number without dashes such as 598374239.  The system will then display 598 37 4239. (Only enter ss# if a non H.Park Patient) If a H.P patient it only goes in the INS. Section.

E. Street Address   Enter as you would like it to appear on correspondence (e.g. 123 Main St., Apt 14).

F.  City   Enter as you would like it to appear on correspondence.  Do not abbreviate, and watch your spelling as this initial entry may be used for all patients in this city.

G.  State   Enter the abbreviation of the state.  Dentrix will default to    the state that appears in your Practice Information, so you may tab past this field unless the patient is from out of state.

ZIP   Dentrix contains a ZIP code cross-reference file that keeps track of the city and state associated with ZIP codes as you enter them.  When you type a ZIP code already on file, Dentrix will automatically fill in the city and state.  If the ZIP code is a new one, you will need to fill in the City, State.

 

H. Home Phone   Enter the area code and the 7-digit number.  Work Phone and Extension   Enter in the same

manner as the home phone.  Enter an extension number if available.

 

I. Choose their primary provider – Dr.

 

J.  Change their first visit date to the date of visit, if they a non-patient delete there first visit date.

 

K.  Billing type = 7

Now you will double click on each box in the family file and enter information in each section.

Alerts – Add any medical alerts for the patient

You set the recall if it is a 3-6-9 or 1yr recall

 

New Patient situations:

How to schedule new patient adults

How to schedule new patient children

How to schedule new patient multiple children in same family

How to schedule new patient adult and child in same family

How to add insurance for both HealthPark and non-HealthPark patients

 

Scheduling all ortho treatment and visits

There are several types of appointments involved with braces:

 

Consults

Initial exams and Re-evals: 4u in RECD col,

Conference: 2u in RECD col,

 

1.  New Patient evaluations

These are 1 hour visits at no charge for the orthodontist to evaluate the person for braces. At this appointment the orthodontist will discuss with the patient what they expect from treatment, the staff will take pictures of the patient’s face and bite, and also take xrays.

Only put NEW PATIENT EXAMS, RE EVALUATIONS and CONFERENCES in the RECD col.

Do not schedule more than one NP exams or re evaluations at the same time. New patient exams and conferences are best scheduled before 3:30 pm.

Initial exam, re-eval, and conference is found in the initial box.

 

2.  Records

This appointment is the first step in getting braces. The assistant takes models, and more X-rays (panoramic and cephalometric), and places the spacers if needed (to make room for bands/braces).

Records appointments (4 units) are to be scheduled on Friday mornings.  The staff has to pour the models and they have to harden before they can remove them.  This takes about 30 minutes of staff time.  Since we keep the afternoons for adjustment appointments to accommodate as many after school checks as possible, we don’t want to tie up a staff person doing models, plus it’s not fair to make them stay late to pour models.

 

To schedule – It will be in the tooth chart (Treatment planned)

When scheduling records or any treatment, patient or parent must understand financial obligations required for completion of treatment.  This is to be finalized before making the appointment that starts treatment.  Call the insurance company (prior to the conference) to verify eligibility, maximum benefits and percentage of payment so you can make the financial arrangement.  If you don’t know how to do this, ask someone to do it for you, but don’t just schedule the appointment without having done this most important step.  When making the appointment to begin any treatment, place a consent form and set of helpful tips information sheets in the folder, along with a new treatment sheet. (It is best to do this before the patient comes in for exam)

 

3.  Bandings

This appointment is where the bands/braces are placed on the teeth is scheduled 6 units.

Banding appointments are to be scheduled in the morning in the RCK1 or RCRD column

At this appointment, the patient will receive their coupon book (which is how they make their monthly payment for braces.)  They will also receive an ortho user’s guide from the assistant of how to care for braces.

To schedule – find the ortho tx in the tooth chart (Treatment planned)

 

4.  Adjustments “ortho visit”

These range from 15-45 minute appointments generally 6-8 weeks apart. The 45-minute appointments should be before 2 pm and the 15-30minute appointments can be scheduled anytime to accommodate school schedules.

To schedule – use the initial box and schedule “ortho visit”

Adjustments can be scheduled in any column (except RECD and RCRD in the a.m. nor the XTRA col).

Its okay to schedule adjustments up to 8 weeks – but if they are to be seen later than that, go to the family file, double click on continuing care, select ortho and change the future date to the date they are due.

Once the braces are on, the teeth will move slightly within the mouth causing the wires to loosen. Patients come in routinely for adjustments to have the wires tightened, clipped and checked to make sure the teeth are moving into the correct position.

 

5.  Removals/ Seat Retainers “deband”

Schedule 4 units on Fridays before 2pm. The staff will also take models to make the retainers at this appointment.  The patient can wait approximately one hour for the retainer to be made or come back to have fitted and seated.

To “remove appliance” – go into treatment and choose “remove braces, orthodontic retainer and seat retainer”

 

Do not have a patient return for seating appointments after 4 PM since Dr. Khan may need to make adjustments. (No actual appointment is necessary, just verbally tell the patient what time to return)

 

7.  Emergencies

If a band breaks – unless the patient is in pain or a wire is poking them, they can wait until their next adjustment appointment. If they need to be seen, you can schedule them for 2 unit with the orthodontist to fix the problem. (If the orthodontists are not going to be in for several days and the patient is in pain, you can also bring them in as a 2unit emergency exam with the GP dentist staff- only to get the patient out of pain.)

(schedule with zz account, no need to pull chart of fill out emergency form – assistant will put clinical note in ortho account for Dr .

 

8.  “Dr. other patients”

Dr. has two other offices than just Healthpark Dentistry.  Sometimes these “other office” patients have orthodontic emergencies that cannot wait until he makes it back to those offices.  Therefore, when he is here at Healthpark we will see these patients for the problem that needs to be addressed.  Usually, during huddle, Dr. will let you know that he is expecting one of these patients, they usually do not call Healthpark for an appointment they contact Dr. .  However, we still need record of seeing them in our office.

 

When these patients arrive – look up name “Dr. other patients” in the family file – there are numbers following this “name”. Add the patient name as additional family members to this account until the list is full (max is 18 members).

 

How to Schedule “Dr. other patients”

 

“Dr. other patient” Check Off Sheet:

  •    When patient arrives, give them an ortho health history
  •     Enter patient’s name in the family file under “Dr. other patients”
  •     Look for the last family file number (#7, #8, etc.) and select the latest one
  •     If there are too many patients in the last #file, you will need to create a new file name.  “Dr. other patients” plus next number available.
  •     Enter patients name, birthday, phone number and address only
  •     Pop up will ask either 1) changed address for all or 2) add as new address
  •     Select: add as new address
  •     Since ortho is a bulk fee and already charged at the other office, there is no reason to get insurance info.  Nor is there any special fee for this visit.
  •     Attach yellow ortho treatment sheet to health history and put on wall for assistant to take back
  •     When patient checks out, no future appointment should be necessary, the patient will follow up with Dr. Khan at another office
  •     Dr. will make Dentrix clinical notes
  •     File paperwork in “Dr. other patient” chart

 

 

Notes for Calling Ortho Confirmations

When confirming ortho appointments, the only ones that you call are:  new patients, banding and record appointments. (No calling the adjustment appointments.)

 

To schedule ortho appointments on the computer:

Open appointment book module

Type in zz name. The zz before the last name indicates that the person is a Dr. patient.

Click Initial – and choose the reason for the visit. If the appointment is for an adjustment, simply choose Ortho Visit.  May need to go to Misc then Orthodontics to choose seps, bands, retainer check, etc.

Set the length of the appointment

Choose your name in the staff list

Make sure Dr. is provider

Click okay to schedule

 

Many times you will receive these two messages from the computer:

“Provider has time block in another operatory”

“Provider has another appointment at the same time, do you want to double book?”

 

Click okay to these messages. The time block message appears because we have set up several time blocks (which you can see as the black outlined boxes) for each of the columns instead of just one. The double booking message appears because we book our doctors in multiple columns. The computer will only allow us to book a provider in multiple columns by taking out the “xxx” in the appointment time.

 

Scheduling daytime appointments for orthodontics – adults

Most of the adult orthodontic clients in our practice work.  This means they will have to leave work for their appointments.  You can’t blame them for wanting to avoid this at all costs.  Dentistry is expensive enough without losing the income you need to pay for it!  No matter how much you agree with these client’s feelings, they still must be appointed during the day.

 

Your job is to make this as acceptable to the clients as possible.  Even though it won’t be convenient for the clients, remember the facts:

a. Companies do allow employees to miss work

b. Employees have vacation, free days, sick days, etc. so they can be paid while missing work to make their appointments.

 

Now that you feel better about enforcing our office policy, here’s how to help your client feel better about it.

a. Once the banding is done, the appointments will be short.

b. Find the best time for your adult clients’ exams:

c. First appointment in the morning

d. Just before or after lunch

e. Last appointment of the day

f. Emphasize that they will be given priority on these times for their convenience!

 

Scheduling daytime appointments for orthodontists – children

Parents don’t like their children to miss school.  Accept this fact.  Also, as adults, we’ve all learned we have to do things we don’t want to do.  This is one of those times.

 

First, agree and sympathize with the parent.  Then appeal to their sense of fair play.  Everyone wants the after school and Saturday hours.  Therefore everyone will take turns getting convenient and   inconvenient times.  The only exception is working adults who will be given more of the convenient times so they can avoid missing work.

 

Next, list the reasons why it’s ok for their child to miss some school.

a)     State law makes medical and dental appointments excused absences.

b)     If the child reports to school on time and then leaves, s/he won’t be marked absent or tardy.

c)     The appointments rarely will take more than 15 30 minutes.

d)     We will try to work them into a study hall or non-essential class.

e)     Be able to explain what is done in each type of appointment.

 

Finally, identify which charts have additional information that needs to be reviewed by a senior level secretary.

 

Orthodontic Scheduling Test

Set up a new patient with an orthodontic account

Schedule new patient orthodontic exam for an orthodontic patient

Set up a new patient that is a child for an orthodontic account

Schedule a HealthPark Patient for a new patient ortho exam

A patient calls and says they saw Dr. one month ago and would like to schedule their next appointment, what would you do?

Schedule a patient that needs an Adjustment

Schedule a Banding appointment

Schedule a Records appointment

Seat retainer

 

_____________________________________                          __________________________

(ortho coordinator)                                            Date

 

 

C.  Periodontics

Dr. (Periodontist)

Dr. is a Periodontist (Gum specialist). She provides gum surgery 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.

On Wednesday morning, print out Hygiene for that Friday, put in the hygienist bins and they will circle the patients that they want Dr. to check on Friday. They should return this sheet to you.  Please make sure there is a block with patient’s name in Dr. schedule so she is prepared to see that patient.  On Thursday, you need to print out Dr. schedule for Friday.  She generally performs the following periodontal treatments:

 

Gum surgery (See the Gum Surgery brochure) – to heal deep gum pockets

Grafts – to heal deep gum pockets

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

 

She also performs some oral surgery treatments:

1.  Wisdom teeth extractions

2.  Other extractions

3.  IV sedation with Dr. Devany (occasionally)

 

You are responsible for the following:

1.         Entering new patients – whether referred by HealthPark or from outside HealthPark

2.         Scheduling all treatment, perio maintenance

3.         Get to know Dr.

4.         Fill the schedule

 

Entering new patients

To schedule a new perio patient:

Code: D0180 (Comprehensive perio eval) – Perio category

Time: 2 units (3 if no X-rays are available)

Fee: $98

X-rays: Have the patient bring their CMX if they have one (or if a HealthPark patient, make sure the most recent CMX is in the front of the chart so Dr. can easily find it) if they do not have one, then we can take a CMX for them.

Make sure you have a referral form.  The chart needs to have a blue treatment sheet, a blue ‘salmon’ sheet and a blue perio charting sheet.

 

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, is panoramic X-ray available, what treatment is needed and referral source and form.  The chart needs a blue treatment sheet and a blue ‘salmon’ sheet.

 

*Confirm with the patient that Dr is not a member of any dental insurance plans in the TippCity office.  She is a provider with United HealthCare.  If she is seeing a patient regarding wisdom teeth and the patient has Superior insurance, please inform the patient that Superior will not cover for Dr. to do the extractions, as her specialty is perio and not oral surgery.

Make sure you have a referral form for all new patients.  You  will type up a letter to all referring doctors, advising of what treatment done/recommended and when next appointment is.

Scheduling treatment, perio maintenance

 

Periodontics:

Initial exams for clients to be evaluated for periodontal treatment – schedule Cmp Perio Eval (periodontal code D0180) – 2u with recent CMX or if only a 1-2 X-rays may be necessary, 3u without CMX.  If X-rays are necessary, make sure assistant is licensed to take X-rays.  Dr. will advise on treatment time when checking out.  Standard financial arrangements apply when scheduling Dr. .

 

Dr. does some oral Surgery:

Initial exams for clients to be evaluated for oral surgery – schedule Spec Exam (oral surgery code 00150) 2u with recent pano, 3u without pano.  If X-rays are necessary, make sure assistant is licensed to take X-rays.  Dr. will advise on treatment time when checking out.  Standard financial arrangements apply when scheduling Dr. Hamal.  Remember, Superior insurance does not cover Dr. to perform extractions of wisdom teeth.

 

Oral sedation:  Dr. must first review the current health history to ok oral sedation.  There is no added in-office fee for oral sedation – just the cost of the prescription – this is called in 1-2 days prior to the appointment.  Follow Dr. Smith’s Halcion protocol.  Make sure the Halcion prescription form is completed by Dr. and is in the chart.

 

IV sedation:  Dr. must first review the current health history to ok IV sedation.  Dr. Viola Devaney will need to be scheduled for the IV sedation portion of the treatment.  Her fee if $560.00 for the first half hour and $50.00 for each additional 15 minutes that follows.  The client must pay Dr. Devaney’s fee to schedule the appointment.  Schedule a “block” in the side columns next to the appointment so that no re-check appointments are scheduled during this procedure.

 

To schedule surgery rechecks:

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

 

Perio maintenance: Time 3 units

Code: D4910 (Perio maint with Specialist) and D0120 (periodic exam – charged only 2 per year)

 

 

Perio scaling and root planing:

For 1-3 teeth, code D4342 Time: 2u

For a quadrant, code 4341   Time: 4u

 

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

Per tooth, code D4211 Time: 1&2u

Per quadrant, code 4210 Time: 1&4u

 

Gingival flap: (This is resecting the gums and getting access to the roots of the teeth.)

For 1-3 teeth, code 4241 Time: 1&3u

For a quadrant, code 4240 Time 1&4u

 

Crown lengthening – Code 4249 Time – usually 3u (and 1u anesthetic) 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

Code 4263 and 4264 (additional sites) – 1&4u

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 or with extractions.

 

Soft Tissue graft – Time: 1&3u

There are 3 types:

1.         Connective tissue graft – Code 4273

2.         Free gingival graft – Code 4271

3.         Double papillary graft – Code 4270

 

Distal wedge Code 4274   Time 1&3u

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

 

Biopsy   Time 1&2u

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

 

Oral Surgery: (Remember, Superior insurance will not cover extraction of wisdom teeth by Dr. .)

 

Single tooth or several simple extractions – 1&2u to 1&4u (check with her if unsure with multiple extractions)

Full  mouth extraction – 1&6u to 1&8u

All wisdom teeth (no impactions) 1&4u

If soft tissue impacted:1&5u or 1&6u

Complete Bone Impacted: check with Dr Hamal

 

Frenectomy Code 7960 Time 1&2u

 

Surgical exposure of impacted tooth for orthodontic purposes – Code 7281 Time 1&3u

 

Prescriptions

Dr. will prescribe Halcion as an oral sedative following Dr. Smith’s protocol located in the assistant levels.  There is a prescription form for Halcion that must be filled out and followed.

 

Apicoectomy

1 Apico (cyst on bone)            1&6u

2 Apicos                                  1&8u

 

Biopsy

Small               1&2u

Large               Consult with Dr.

 

Consultations

Complex medical history        30 minutes

 

Patient Questions for Oral Surgery

Ask patient if they would like to have

1.         Local anesthesia

2.         Nitrous oxide

3.         IV anesthesia

 

If patient has IV anesthesia

1. Give pre-op instructions (please read)

a.) if appointment is morning – nothing to eat after midnight the night before

b.) If appointment is afternoon – Patient cannot eat after midnight the night before but can have up to 2

ounces of clear liquid two hours before surgery.

c.) Must have someone to drive him or her home.

d.) Wear a short sleeve shirt.

 

If patient has medical problems

1. Ask patients if there are any medical problems we need to know about

Any chronic health problems

Currently under the care of a physician for any condition

Currently taking any medications (including an aspirin a day)

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

 

Aspirin or Blood Thinners – cause bleeding during surgery

If they are taking aspirin or a blood thinner (i.e.: 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 advice 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 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 Dr. in Dentrix:

a) Select name

b) Select provider in the family file – in the first column for any treatment and conferences/rechecks in the second column that his staff will do

c) Go to the tooth chart, select the teeth that need treatment and treatment plan them from the Oral Surgery category

d) Schedule in the appt book using the treatment plan you’ve created.

e) Select the length of the appointment

f) Click the staff button and select your name (to show who made the appointment)

g) Click okay

h) Add any notes to the appt

 

Also, advise the client that exams with Dr. 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.

For extractions of only 1-2 teeth if the person is healthy, you can schedule the exam and treatment in the same appointment.  Use 0150.1 Specialty Exam with Treatment.

We maintain a broken list of patient who canceled or no showed for appointments with Dr. , and keep patients on the ASAP list if they would like to be called to come in sooner as schedules allow.

 

PATIENTS TO BE SCHEDULED – Periodontic Scheduling Test

1.    Deana AA Kortis – Calls to schedule appt to see Periodontist and has a referral from Dr. GP

2.    Oliver AA Twist – Dr. Smith recommends he schedule exam with Dr for possible oral surgery.

3.    Blue AA Bird – Calls to schedule a perio maintenance appt with Dr.

4.    Charles AA Smith – Referred by Dr. GP for a possible implant.

 

 

___________________________________

Periodontic Coordinator signature – I have thoroughly trained & am confident of her ability to accurately schedule perio patients.

 

 

D.  Implants

Dr. does the entire implant process by herself. She does the exam, the surgery to place the implant and the final crown.

Dr. and Dr. work with Dr. on the implant process. The GPs usually recommend an implant as part of their comprehensive exam and CMX and then Dr. will do the implant exam and pano plus diagnostic casts. Dr. does the surgery to place the implant. The GPs place the abutment and then the final crown.

 

There are two different multi-codes for implants – depending on which dentist is doing the implant.

 

Dr. Implant

1.     To treatment plan, go to the Tooth chart for your patient.

2.     Treatment plan extractions and other treatment.

3.     Select multi-codes, Implants Dr.

4.     This will automatically add several codes to your treatment plan and draw the implant on the tooth chart.

5.     You need to put the codes in the following order (in the Tx Plan Presenter, click Set Order)

 

D0150

Implant exam

 

D0330

Panoramic film (X-ray)

 

D6010

Root form implant

 

D6056

Prefabricated Abutment

 

D6059

Implant crown Posterior PVC

 

D2900

Seat crown

If you are doing an anterior tooth, then delete the crown code and enter D6059.1 Implant crown Anterior PVC instead.

At times, an interim prosthesis (flipper) will be required- use code D5820 (upper) and code D5821 (lower).  This will be needed for implants on front teeth.  The insurance companies will usually pay 50% for these.

 

Implants Periodontist & GPs

1.     To treatment plan, go to the Tooth chart for your patient.

2.     Treatment plan extractions and other treatment.

3.     Select multi-codes, Implants Periodontist & GPs

4.     This will automatically add several codes to your treatment plan and draw the implant on the tooth chart.

5. You need to put the codes in the following order (in the Tx Plan Presenter, click Set Order)

Dr PD

D0150

Implant exam

 

D0330

Panoramic film (X-ray) (if not done at comp exam appt)

Dr GP

 

Surgical Guide

Dr PD

D6010

Root form implant

Dr

D7900

After surgery rechecks (2-3 rechecks –  at last or 2nd to last recheck will have PA)

Dr PD

No code

Exposure

Dr Pr

D6056

Stock Abutment

 

D6059

Implant crown Posterior PVC

Dr GP

D2900

Seat crown

If you are doing an anterior tooth, then delete the crown code and enter D6059.1 Implant crown Anterior PVC instead.

At times, an interim prosthesis will be required- use code D5820 (upper) and code D5821 (lower).  This will be needed for implants on front teeth.  The insurance companies will usually pay 50% for these.

 

As our GPs work out the details on how they want to work with Dr. on implants, here are their initial ideas :

If a client is considering having an implant, schedule for comp exam with the GP. Schedule this for 2u staff (to take a cms or pano) and then a 2u implant exam with Dr later.After this consultation, you need to treatment plan the implant using the above multi code and any additional surgeries recommended by Dr . The dentists will also let you know how long the appointments will need to be and how much time to allow between each. Call insurance and ask if they pay for the implant – expect to send a PTE to verify coverage. You will follow FA’s just like we do for formal treatment plans.

 

E.  Advanced GP Scheduling

 

We have different methods of sedation, one being Halicion (code D9998.1).  Insurance typically does not pay for this so the patient should expect to pay the $67 fee for this and that should be explained to the patient prior to treatment.

 

To treatment plan and schedule an immediate denture

An immediate denture is when a patient will have his teeth extracted and a denture seated in the same appointment so they do not go without teeth.

 

To treatment plan, go to the Tooth chart for your client.

Treatment plan extractions and other treatment before the immediate denture.

Select multi-codes, Immediate Upper denture or Immediate Lower denture and Tx

This will automatically add several codes to your treatment plan and draw the denture on the tooth chart.

You need to put the codes in the following order (in the Tx Plan Presenter, click Set Order)

 

1

D5140

Immediate denture (Upper or lower)

$1649

2

D5892

Try In

 

3

D5890

Seat complete denture

 

4

D5851

Viscogel liner (upper or lower)

 

5

D5750

Reline complete denture

Comes up $393, you need to change it to $0

 

Change the fee for the reline to $0 – the reason we do this is to maximize the patient’s insurance benefit.

Insurance will not pay for a reline on a new denture (although one is always needed for a new immediate

denture as the patient heals from the extractions, it makes their denture fit differently), so we increase the fee for the Immediate denture (as compared to a regular denture fee) by $360 and then do not charge for the reline. (FYI, if a patient comes to the practice with an existing denture and asks us to reline it, and then we will charge the reline fee.)

To coordinate scheduling with the extractions, make sure the extractions are scheduled for the same appointment as the Seat complete denture (step 3).

 

Cantilever Bridge is similar as a conventional bridge except that it only has 1 tooth and 1 false tooth involved not the normal 3 teeth.

 

The codes are:  D6241 Pontic (for the missing tooth)

D6751 Retainer (for the anchor tooth)

 

Maryland Bridge is similar to a conventional bridge except:

The 2 retainer teeth enamel are slightly reshapedSince the metal frame is only bonded to the retainers. Retainer fees are much less.This design may be used to splint several teeth together so the dentist will tell you how many teeth are involved.

 

The codes are: D6545 Retainer tooth – etched bridge

D6241 Pontic (missing tooth)

D6545 Retainer tooth – etched bridge

 

To treatment plan a Plastic partial denture

A “flipper ” is a plastic partial that replaces one or several teeth. It is code D5211 for upper and D5212 for lower. This type of partial does not include any metal clasps and is the cheapest option for replacing missing teeth. There are no clasps – it is all plastic.

 

The second type of partial has metal clasps and can replace one or several teeth. To find out which type of plastic partial the dentist wants to make, you must ask the dentist:

Are there any clasps?How many teeth is this partial replacing?Which teeth #’s does this partial replace?

 

To treatment plan, go to the Tooth chart for your patient.

Select one of the missing teeth and then Treatment plan Category Pros, Removable, then 5211.1 for Upper plastic partial or 5212.1 for Lower plastic partial.

Next, find out from the dentist – How many clasps will they need? Find out the tooth numbers of teeth to be replaced.

Next, check your printed fee schedule for costs for additional clasps ($40 each as of 12/08) and each additional tooth ($20 each as of 12/08). On a calculator, figure out the additional cost and then double click on the code for plastic partial and change the fee by adding the plastic partial fee plus the additional clasps and additional teeth costs.

 

To treatment plan a Cusil Partial Denture:

A Cusil partial denture is an all plastic partial that looks and fits like a denture but has holes for a person’s remaining teeth to fit through.

 

To treatment plan, go to the Tooth chart for your patient.

Select multi-codes, Cusil partial denture.

This will automatically add several codes to your treatment plan and draw the denture on the tooth chart.

You need to put the codes in the following order (in the Tx Plan Presenter, click Set Order)

 

1

D5861

Cusil partial denture

$1241

2

D5892

Try In

 

3

D5891

Seat partial denture

 

Scheduling Form for Partials / Dentures / Implants – Dr. Pierson

 

Metal Frame Partial Denture

 

Impressions & charge out the partial (5213 or 5214)

 

 

— Wait 2-3 weeks for the lab –

Wax try in (5892)

 

 

— Wait 1-2 weeks  —

 

Seat partial denture (5891)

 

 

Regular Complete Denture (upper or lower)

 

Impressions & charge out the denture (5110 or 5120)

 

—  Wait 3 weeks for the lab —

 

Try in (5892)

Seat complete denture (5890)

Then 2 rechecks also – use continuing tx.

 

Plastic Partial Denture

 

Impressions & charge out the partial

 

—  Wait 1 week for the lab —

 

Seat partial denture

Immediate Denture

 

Impressions & charge out the denture (5130 or 5140)

 

—  Wait 3 weeks for the lab —

 

Try in (5892)

Extractions & Seat complete (5890)denture

 

Viscogel liner (5850)

 

Reline complete denture (5750)

 

Implants

 

Dr. – Implant surgery, root form implant (6010)

 

 

Dr. – At least 3 after surgeryRechecks

 

— Wait 3-6 months for healing & make sure abutment & crown are back from lab —

 

Dr. _____ – Implant impression

 

— Wait 3 weeks for lab  —

 

Dr. ________ – Place abutment (6056) & place crown (6059)

Scheduling Form for Partials / Dentures / Implants – Dr.

 

Metal Frame Partial Denture

 

Impressions & charge out the partial (5213 or 5214)

 

 

— Wait 2-3 weeks for the lab –

Framework try in (5892)

 

 

— Wait 2 weeks  —

 

Wax try in (5892)

— Wait 2 weeks  —

 

Seat partial denture (5891)

 

Regular Complete Denture (upper or lower)

 

Impressions & charge out the denture (5110 or 5120)

 

 

—  Wait 1 week  —

 

Wax rims (5892)

—  Wait 1 week  —

 

Esthetic try in (5892)

 

—  Wait 1-2 weeks  —

 

Seat complete denture (5890)

 

—  Wait 2 days–

 

Post op check / denture adjustment (5410 or 5411)

 

Plastic Partial Denture

Impressions & charge out the partial

 

—  Wait 1 week for the lab —

 

Seat partial denture

Immediate Denture

 

Impressions & charge out the denture (5130 or 5140)

 

—  Wait 1 week  —

 

Try in (5892)

—  Wait 1-2 weeks  —

Extractions & Seat complete denture (5890)

 

—  Wait 1 day–

Post op / denture adjustment (5410 or 5411)

—  Wait 2-4 weeks —

 

Viscogel liner (5850)

 

Implants

Dr. – Diagnostic casts (0470), surgical guide (6190)

Dr. – Implant surgery, charge out the root form implant (6010)

Dr. – At least 3 after surgery rechecks

— Wait 2-6 months for healing & make sure abutment & crown are back from lab —

 

Dr. – Implant impression (Code??)

Dr. – Place abutment (6056) & Place implant crown (6059)

Bridge

4u Doc time     Bridge prep & charge out the bridge

— Wait 2 weeks for the lab  —

2u Doc time     Seat bridge

 

To treatment plan a Regular Bridge:

A regular bridge means that we are doing 2 PVCs (porcelain veneer over metal crown) and a pontic (fake tooth).

 

To treatment plan, go to the Tooth chart for your patient.

Select multi-codes, regular bridge.

This will automatically add several codes to your treatment plan and draw the denture on the tooth chart.

You need to put the codes in the following order (in the Tx Plan Presenter, click Set Order)

 

1

D6751

Bridge Retainer

$873

1

D6241

Bridge Pontic

$873

1

D6751

Bridge Retainer

$873

2

D6900

SeatBridge

$0

 

To treatment plan a Metal Bridge:

Occasionally, the doctor may want to do a bridge with all metal crowns. If so, then you are using the following codes.

 

To treatment plan, go to the Tooth chart for your patient.

Select multi-codes, Metal bridge.

This will automatically add several codes to your treatment plan and draw the denture on the tooth chart.

You need to put the codes in the following order (in the Tx Plan Presenter, click Set Order)

 

1

D6791

Full Metal Retainer

$852

1

D6211

Metal Pontic

$794

1

D6791

Full Metal Retainer

$852

2

D6900

SeatBridge

$0

 

If the doctor wants to do some PVCs and some metal crowns, then just find out which ones – and use the correct codes – just cherry pick from the codes above.

 

To be signed off on the Advanced Scheduling section, you must treatment plan the following – include all the columns to show fee & insurance portion (assume out of network plan):

Use multi-codes regularlyTreatment plan an all plastic partial for missing tooth # 9Treatment plan a plastic partial for missing teeth #9, 13, 4 – with 3 claspsTreatment plan a metal frame partial dentureCusil partial dentureComplete upper and lower denturesImmediate dentures both upper & lower (treatment plan all teeth to be extracted)Reline for upper complete dentureImplant by Dr. Hamal & Dr. Pierson to replace missing #13 – and note which dentist for each apptGingival flapFull braces for 16 year oldTMJ splintAll whitening options – show as A, B, C and discussRegularBridgePrimary teeth – pulp, crown, extraction & space maintainerCore buildup and crown #12 – show options for metal crown vs. all porcelain vs. gold and discuss

For each one of these cases, you must print a Dentrix Tx plan on an AA patient and then bring the associated handouts and the tx plan to a meeting with Jill. Your job is to discuss the treatment and the fees with Jill. (Get ready for some insurance questions too!)

 

Sign offs

________________________________                                 ______________________

Manager   Date

______________________________                                   ________________________

Team Leader                                                                           Date