The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 1
Code Definitions…
Tricks of the Trade…
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 2
D 4341 – Quad SRP
D4341: general bleeding on probing 4-5 mm pockets plus presence of calculus along with radiographic evidence of bone loss.
CDT 2009/2010 defines a quad as “4” teeth or more.
D4910 follows SRP with typical 90-day exclusion.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 3
D 4341 – Quad SRP
Most insurance companies have a
24-36 month exclusion for retreatment Include diagnostic films to document
bone loss. Narrative check list is often not
appropriate.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 4
D4342 – SS SRPD4342 – SS SRP
D4910 always follows D4341/D4342. For a few isolated teeth – D1110
may be appropriate. Always put the tooth # on the
insurance form. D4342 is active therapy – not
prophylactic (D1110) or supportive (D4910).
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 5
D4342 – SS SRP along with D1110
If both 4324 & 1110 are necessary:
Consider D1110 1st appt., D4342 2nd When D4342 is performed first -
may trigger 90 exclusion of prophy
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 6
The Big Reveal by MetLife, CIGNA, Delta Dental
As reported in:
Insurance Solutions Newsletter
September/October 2008 issue
888-825-0298
www.dental-ins-solutions.com
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 7
D4341 / D4342 – MetLife requires >4mm
pockets + attachment loss
Pseudopockets without bone loss
should be coded D1110
The Big Reveal by MetLife, CIGNA, Delta Dental
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 8
MetLife now pays SRP once every 24 months.
MetLife reviewed 1,750,000 claims for D4341 / D4342 in 2007.
All 3 now allow payment for D1110 and D4342 on the same day.
The Big Reveal by MetLife, CIGNA, Delta Dental
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 9
D4910 – MetLife pays 4x year for most policies.
SRP should only be reported again if there is evidence of progression of disease (further attachment loss, bleeding, recession, discharge, etc.).
The Big Reveal by MetLife, CIGNA, Delta Dental
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 10
MetLife no longer denies D4910 if billed
within 90 days of D4341/D4342.
MetLife requires 2 quads of D4341
before covering D4910 (unless narrative
states only one quad was infected).
The Big Reveal by MetLife, CIGNA, Delta Dental
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 11
CIGNA DHMO only covers D4910
2x year for the first 12 months
following active therapy.
Delta varies depending on Delta plan.
The Big Reveal by MetLife, CIGNA, Delta Dental
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 12
The Big Reveal by MetLife, CIGNA, Delta Dental – D4381
CIGNA does not define a minimum pocket depth for D4381.
When a CIGNA plan covers D4381 there if benefit for up to 8 teeth at the time of SRP.
If 9 teeth are treated, CIGNA denies all. Delta requires 5 mm pockets that bleed.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 13
Delta covers up to two teeth per quad
but not until the 6 week re-evaluation
after SRP. MetLife will cover D4381 w/ 6 mm
pockets at the time of SRP.
The Big Reveal by MetLife, CIGNA, Delta Dental – D4381
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 14
MetLife will only pay D4381 on the
same tooth once in 12 months.
MetLife believes systemic antibiotics
are more appropriate when more than
12 teeth are infected.
The Big Reveal by MetLife, CIGNA, Delta Dental – D4381
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 15
Narrative Check ListNarrative Check List(for internal use – not insurance)(for internal use – not insurance)
Active disease with alveolar bone loss Active disease with alveolar bone loss _____ or greater loss of perio attachment_____ or greater loss of perio attachment Radiographic evidenceRadiographic evidence Bleeding on probingBleeding on probing Gingival recessionGingival recession Furcation involvementFurcation involvement InflammationInflammation Increasing tooth mobilityIncreasing tooth mobility Subgingival calculusSubgingival calculus SuppurationSuppuration
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 16
Narrative for All Four Quads on the Same Day
Purpose: to disinfect the entire mouth _____ minutes spent on appointment _____ anesthesia used _____ pre-medication used Apprehensive patient Medical
condition:____________________ Travel time _________________________
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 17
D4355 Gross Debridement
Only used when comprehensive exam D0150 or comprehensive periodontal exam cannot be performed due to excessive and bulky calculus, heavy plaque and debris buildup.
Comprehensive evaluation generally follows debridement typically 14 days later.
D4355 generally reimbursed 25-33% of the time.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 18
D4355 Gross Debridement
D4355 is not a definitive treatment. A prophy, referral to periodontist, or
scaling and root planing always follows this preliminary procedure.
D4355 should not be reported as a “first prophy.”
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 19
D4381 Localized Delivery of Antimicrobial Agents
Placement of FDA-approved localized antimicrobial agents such as Arestin®, PerioChip® and Atridox®.
It is adjunct to D4342 or D4910. The code may not be reimbursed at
the initial SRP appointment. Trend is to pay at first appointment.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 20
D4910 Periodontal Maintenance
This procedure follows perio therapy and continues at varying intervals, determined by the clinician.
D4910 does not include the evaluation – always charge separately.
This procedure is on-going and therapeutic, not preventive.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 21
D4910 Periodontal Maintenance
Typically has a 90-day exclusion following active therapy.
It is improper to alternate between 1110 and 4910.
The patient cannot be a perio patient one visit and prophy visit the next.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 22
D9910 Application of Desensitizing Medicaments
May be used as an adjunct to SRP or
for treating sensitivity
Not typically reimbursed
Consider D9110 – palliative
treatment – for sensitivity
at an emergency visit.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 23
Subgingival IrrigationLocal Drug Delivery
Atridox® – doxycycline gel that conforms to the gum surface and then solidifies over the next few days.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 24
Subgingival Irrigation Local Drug DeliveryLocal Drug Delivery Elyzol® – is a gel or strip applied to the
gum that is composed of metronidazole. Effective against parasites as well as bacteria. Studies show Elyzol achieves a greater bacterial reduction where doxycycline works faster.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 25
Subgingival Irrigation Local Drug Delivery
PerioChip® – Placed into the gum pocket after scaling, the chip slowly releases chlorhexidine – a powerful bacteria-killing antiseptic. Reduction of pocket depths is reported – but it is not known whether these improvements are sustained.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 26
Subgingival Irrigation Local Drug Delivery
Minocycline microspheres (Arestin®) contain antibiotics in tiny capsules. Studies report they are more effective in reducing pocket depth and bone loss than standard perio maintenance. Patients obtain these benefits regardless of their smoking status, age, gender, or extent of disease.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 27
Local Drug Delivery
Perio ProtectPerio Protect™ – home care treatment program for – home care treatment program for
perio disease.perio disease.
Medial device is a set of custom fabricated Perio Medial device is a set of custom fabricated Perio
Protect Trays .Protect Trays .
The trays guide antimicrobial agents into the The trays guide antimicrobial agents into the
infected area (gingival sulcus) and maintain the infected area (gingival sulcus) and maintain the
medication for a specific time.medication for a specific time.
Must be a licensed Perio Protect partner.Must be a licensed Perio Protect partner.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 28
Systemic Antibiotic Therapy
Periostat® - subantimicrobial dose doxycycline (SDD) .
Very low dose (20mg) doxycycline is too low to affect bacteria .
The drug blocks matrix metalloproteinase –
enzymes that destroy the connective tissues holding the teeth.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 29
Taken 2x day for months. Several 12-month studies report
significant improvements in tooth attachment and pocket depth with no increased incidence of side effects.
Systemic Antibiotic Therapy
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 30
Irrigation RecommendationsPovidone-iodine: 10% concentration applied repeatedly by
an endodontic syringe to obtain a contact time of at least 5 minutes.
Generally performed after SRP. May also be done prior to mechanical
debridement to reduce risk of bacteremia.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 31
Povidone-iodine: Ultrasonic scaler usage - 10% solution
is diluted by mixing 1 part solution with 9 parts or less of water.
Povidone-iodine mouth rinse/gargle has shown a reduction in gingival surface bacteria by about 33%.
Irrigation Recommendations
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 32
Povidone-iodine: American Heart Association suggests
that antiseptic mouth rinse applied immediately prior to dental procedures reduces the incidence or magnitude of bacteremia.
Irrigation Recommendations
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 33
Sodium hypochlorite (household bleach)
Benefits: Broad antimicrobial activity Rapid bactericidal action Relative non-toxicity No color, no staining Ease of access, very low cost
Irrigation Recommendations
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 34
Sodium hypochlorite (household bleach) Household bleach usually contains 5.25-
6.0% chlorine. 1 part bleach combined with 49 parts
water makes appropriate working solution of 0.1% or 1000 p.p.m.
Working solution: 1 tsp. bleach to 16 oz. water delivered subgingivally via oral irrigator at a high pressure setting.
Irrigation Recommendations
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 35
Irrigation RecommendationsChlorhexidine
Chlorhexidine mouth rinse to combat biofilms
in supragingival and oral mucosal sites are
performed with 10-15 ml of .12-0.2% solution
for 30 seconds 2x / day.
Chlorhexidine has a propensity to dark-stain
teeth and tooth-colored restorations.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 36
Chlorhexidine
.2% Chlorhexidine is usually not
effective for subgingival irrigation.
It causes less change in subgingival
microbes than low strength povidone-
iodine.
Irrigation Recommendations
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 37
Chlorhexidine Chlorhexidine chips for subgingival
placement are capable of reducing mean probing depths by less than 1mm in 4-6 mm deep pockets.
It may not cause noticeable reduction in periodontal pathogens compared to thorough SRP.
Irrigation Recommendations
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 38
Case TypingCase TypingCase Type
PD(mm)
BOP(Y / N)
BoneLoss%
Mobiliy (Grade)
Furcations
(Grade)
CAL (mm)
VisualInflammation
0 - Health 0-3 No 0 None None 0 No
I - Gingivitis 0-4 Yes 0 None Nove 0Yes (local or generalized)*
II – Slight Chronic Periodontitis¹ 4-5 Yes 10 I 1 1-2
Yes (local or generalized)*
III – Moderate Chronic Periodontitis¹ 5-6 Yes 33 I & II 1 & 2 3-4
Yes (local or generalized)*
IV – Severe Chronic Periodontitis¹ ≥ 6 Yes 33
I, II or III
1, 2, 3 or 4 ≥ 5
Yes (local or generalized)*
V – Aggressive Periodontitis age is significant factor²
≥ 6 Yes 33I, II or
III 1, 2, 3 or 4 ≥ 5
Yes (local or generalized)*
* Localized disease is defined as ≤ 30% of sites, Generalized ≥ 30% of sites¹ Specific referral may be indicated for additional treatment beyond initial treatment² Specialty referral should be considered
Clinical Attachment Loss
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 39
Guidelines for the Management of Patients with Periodontal Diseases (AAP 2007)
LEVEL 3: patients who should be treated by a periodontist.
LEVEL 2: patients who would likely benefit from co-management by the referring dentist and periodontist.
LEVEL 1: patients who may benefit from co-management by the referring dentist and periodontist.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 40
Soft Tissue Classifications (According to AAP)
Health - Prophy
Coral pink gingiva.
Pointed papilla.
No bleeding upon
probing.
Probing 0-3mm.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 41
Case Type I – Diagnostic Code: “Gingivitis” Plaque induced / non-plaque originLocalized or generalized ( 30% sites)
Edematous gingiva. Bulbous papilla. Probing 0-4mm. Immediate bleeding upon probing may
delay up to maximum of 30 seconds after probing.
Soft Tissue Classifications (According to AAP)
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 42
Case Type II – DX Code: “Slight Periodontitis” Localized or Generalized ( 30% sites)
Edematous and smooth gingiva.
Probing 3-4 mm.
Delayed bleeding upon probing.
Light to moderate calculus sub-and
supragingival.
Soft Tissue Classifications (According to AAP)
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 43
Case Type III – DX Code: “Chronic Periodontitis” Localized or Generalized ( 30% sites) Horizontal and vertical bone loss
Tissue red, texture smooth Probing 4-6 mm Slight mobility Furcation involvement Bleeds easily Heavy sub-gingival calculus
Soft Tissue Classifications (According to AAP)
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 44
44
Case Type IV – DX Code: “Aggressive Periodontitis” Localized or Generalized ( 30% sites)
Horizontal and vertical bone loss
Probing 6+ mm
Generalized tooth mobility
Soft Tissue Classifications (According to AAP)
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 45
Case Typing…
Decisions / Changes
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 46
Prophy
Mirror Explorer Probe Scaler Gracey 1-2
Challenge:
All other instrumentspackaged separately
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 47
Diagnostic Assessment
Assess-ment Health Gingivitis
Slight Perio-
dontitis
Moderate Perio-
dontitis
Advanced Perio-
dontitis
Aggressive / Refractory
Prophy
Fl2
OHI
Prophy
Fl2
OHI
D0417*
D0150
D0120
D0180
D0274
D0277
D0210
D0330
D0417*
D0150
D0120
D0180
D0274
D0277
D0210
D0330
D4355
D9950 (occ anal)
D0417*
D0150
D0120
D0180
D0274
D0277
D0210
D0330
D4355
D9950 (occ anal)
Referral
D0417*
D0150
D0120
D0180
D0274
D0277
D0210
D0330
D4355
D9950 (occ anal)
Referral
D0417 Collection and preparation of saliva sample for
laboratory diagnostic testing
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 48
DX Code: Gingivitis Plaque induced / Non-plaque origin
Localized or generalized ( 30% sites)
D0120 Periodic oral exam D0150 Comprehensive oral
examinationD0160 Problem focused examD0180 Periodontal exam
Gingivitis Coding Appointment 1
Narrative + perio charting
for increased
fee
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 49
Gingivitis Coding Appointment 1
D4355 Full mouth debridement
D1330 Oral hygiene instructions
D0210 Intraoral complete series (including bitewings), or
D0330 Panoramic film, with
D0274 Bitewings – 4 vertical films, or
D0277 Vertical bitewings (7-8 films)
New Code # 273 -3 BWX
Caution: paid
without exam or x-
ray --try 9110 palliative
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 50
D0170 Re-evaluation – limited, problem-focused
D1110 Coronal Polish
D1204 Adult fluoride, or
D1206 Varnish fluoride
D1330 Oral hygiene instructions
Gingivitis Coding Appointment 2
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 51
D0120 Periodic oral examD0150 Comprehensive oral
examination D0160 Detailed and extensive
oral evaluation – problem focused, by report
D0180 Periodontal exam
D0210 Intraoral complete series
(including bitewings)
Periodontal CodingAppointment 1
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 52
This appointment includes
comprehensive perio screening for
pocket depths, bleeding, and
severity, furcation involvement,
recession from the CEJ, plaque
score, mobility, and bone loss.
Periodontal CodingPeriodontal CodingAppointment 1Appointment 1
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 53
D0417D0417 Collection and preparation of
saliva sample for laboratory
diagnostic testing
D4355 Full mouth debridement
D1330 Oral hygiene instructions
D4935 Consultation for diagnosis
and treatment plan
Periodontal CodingAppointment 1
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 54
D4341Periodontal scaling / root planing by quadrant
D4341Periodontal scaling / root planing by quadrant
D4341Periodontal scaling / root planing by quadrant
D4341Periodontal scaling / root planing by quadrant
OR…
Periodontal CodingAppointment 2 & 3
Current theory - Do as many quadrants as possible in one appointment to not cross-contaminate completed quads.
Never more that 30 days between therapies.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 55
D4342 Periodontal SRP 1-3 teeth, #_____, #_____, #_____
D4342 Periodontal SRP 1-3 teeth, #_____, #_____, #_____
D4342 Periodontal SRP 1-3 teeth, #_____, #_____, #_____
D4342 Periodontal SRP 1-3 teeth, #_____, #_____, #_____
D4381 Arestin®, PerioChip®, etc.D1330 Oral Hygiene Instructions
Periodontal CodingAppointment 2 & 3
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 56
D4380 Re-evaluation of periodontal therapy(examine tissue response,
re-measure pockets)
D1110 Coronal polishD1204 Adult fluoride D1206 Fl2 varnish
D1330 Oral hygiene instructions
Periodontal CodingAppointment 4
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 57
Decisions / Changes
Treatment Sequencing…
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 58
Ongoing Maintenance
Case
Indicator Health Gingivitis
Slight
Perio-dontitis
Moderate Perio-
dontitis
Advanced Perio-
dontitisAggressive / Refractory
6 Months•Prophy•OHI
6 Months•Prophy•OHI
• 3 / 4 / 6
months• D4910• OHI• D4381 • UL, UR,
LL, LR• D4342• Other
• 3 / 4 / 6
months• D4910• OHI• D4381 • UL, UR,
LL, LR• D4342• Other
• 3 / 4 / 6
months• D4910• OHI• D4381 • UL, UR,
LL, LR• D4342• Other
• 3 / 4 / 6
months• D4910• OHI• D4381 • UL, UR,
LL, LR• D4342• Other
• 3 / 4 / 6
months• D4910• OHI• D4381 • UL, UR,
LL, LR• D4342• Referral
to
Specialist
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 59
Periodontal Recare SequencePeriodontal Recare Sequence
Appointment 5: 1st recare or 4-6 week evaluation
D0170 Re-evaluationD0180 Periodontal exam
D4910 Periodontal maintenanceD1330 Oral hygiene instructionsD1204 Adult fluorideD1206 Varnish
Fee Waived
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 60
Fluoride Advantages
CARD
C = Caries reduction
A = Antimicrobial
R = Remineralization
D = Desensitizing
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 61
ADA Fluoride AssessmentADA Fluoride Assessment
28% caries reduction with 1 min 28% caries reduction with 1 min swishswish
37% caries reduction with 4 min 37% caries reduction with 4 min foam or gelfoam or gel
74% caries reduction with varnish74% caries reduction with varnish
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 62
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 63
Varnish
D1204 – topical application of fluoride – adult
D1206 – topical fluoride varnish: therapeutic application for moderate to high caries risk patients. NOT to be used for desensitization.
D9910 – application of desensitizing medicament.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 64
Site Specific Perio Treatment
• You must make today’s appointment look different than the last appointment’s prophy.• Use the chart’s documentation as your starting point:
Mrs. Smith, I see by your chart that the last time you were here the hygienist determined there was a gum problem on the upper right between your molars.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 65
Site Specific Perio Site Specific Perio
TreatmentTreatmentThe first thing I want to do is check that area. If you have not had the healing I would expect at this point, I will do a non-surgical procedure to clean the area for you and place an antibiotic in the pocket to promote healing. You cannot continue with the active gum infection. Let me go ahead and get that numb for you while we continue with your healthy mouth cleaning.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 66
Site Specific Perio Site Specific Perio
TreatmentTreatmentThis is a disease-related procedure
and insurance may cover it differently
than the healthy cleanings you are
used to. Would you like me to have
Sue, our financial coordinator, step
back and explain how your insurance
will aid you with this procedure?
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 67
Anesthesia
Oraqix®® – www.Oraqix.com(2.5% lido, 2.5% prilo.)
Emla – www.Drugs.com(2.5% lido, 2.5% prilo.)
Profound (10% Lido, 10% Prilo, 4% Tetracaine) / Profound LiteSteven’s Pharmacy Costa Mesa, CA (800) 352-DRUG
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 68
Decisions / Changes
Periodontal treatment sequencing…Fluoride…
Anesthesia…
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 69
Exam Definitions
D0120 – Periodic oral evaluation – established patient
D0150 – Comprehensive oral evaluation – new or established patient (absent from active treatment for 3 or more years)
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 70
Exam DefinitionsD0180 – Comprehensive periodontal evaluation –
new or established patient.
Patient shows signs or symptoms of periodontal disease and for patients with risk factors such as smoking or diabetes.
Includes: evaluation of perio conditions, probing and charting, evaluation and recording of patient’s dental and medical history and general health assessment. Record: dental caries, missing or un-erupted teeth, restorations, occlusal relationships and oral cancer evaluation.
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 71
There are 3 types of patient exams:
1- to 3-minute exam - Patient is in excellenthealth
- No or minimal case presentation is
needed. 3- to 5-minute exam - New or re-presented
treatment is discussed by doctor.
Increasing Exam EfficiencyIncreasing Exam Efficiency
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 72
7+ minute exam
• Complete treatment plan presented.• Time necessary is noted in huddle.• Doctor does cursory exam at no charge.• Patient is re-appointed for “status exam.” • Fee is charged at status exam.
Increasing Exam EfficiencyIncreasing Exam Efficiency
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 73
The Exam
Data collectionTreatment planningScale / polish40-50 minutes of app’t.
Call doctor for examRun behind!!!
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 74
The Finish – The Exam
Data Collection Treatment planning Call doctor – 10-15 min
Scale / polish Call doctor again 40-50 min
Call doctor againRun behind!!!
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 75
The Finish – The ExamThe Finish – The Exam
Data Collection10-15 minutes into app’t
Green Time • Doctor examines at
his convenience
• Call Doctor again• No time to discuss TX plans w/pt
Yellow Time
Red Time
• Do the hygiene “dance” behind doctor• Role eyes at dental assistant• Apologize to next patient for being late
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 76
The FinishThe Finish – – Doctor enters for the examDoctor enters for the exam
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 77
Acknowledge – Affirm the PatientAcknowledge – Affirm the Patient
“What have you been talking about?”
“What would you like me to look at?”
Blood Pressure
Medical History / Medications
Perio Status
Life Status – “Blue Sheet”
Next Hygiene Visit
Patient Concerns
Previously Diagnosed Treatment
New Findings
The Finish – The Exam
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 78
Baton Pass to the Business Team
“Cheryl, Dr. Smith would like Linda to schedule an appointment to complete treatment on the lower right - either at the end of the week or beginning of next week.”
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 79
Decisions / Changes
Treatment Planning…
The Exam…
The Hygiene Academy™ November 2008Paragon Management Associates, Inc. Page 80
Before you go for a great Before you go for a great evening…evening… Prioritize the Top 5 ideas you would Prioritize the Top 5 ideas you would
like to discuss or implement in your like to discuss or implement in your office.office.
Enjoy yourself this evening – Don’t eat Enjoy yourself this evening – Don’t eat or drink too much!or drink too much!
See you at 8:00 am tomorrowSee you at 8:00 am tomorrow