The Art of Practice Management
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Perio Therapeutics and Beyond
Marianne Harper
Are you sure you've asked?
Marianne Harper
Does your practice have days when it's in a tail-spin? If it's like most, there are plenty of those days. At the end of the day we often wonder if we handled everything completely. Have we covered all the bases especially with our established patients who are there for recare appointments? The routine that occurs with the established patients is simply that very routine and that routine sometimes results in not as much concentration on "have we asked all the right questions". I have a suggestion a recare update form.

I am a big proponent of forms that add efficiency to the dental practice. For over thirty years, the dental practice that I was the administrator of used a recare update form that served us very well. The form is divided into five areas:
Business Office information – The first section is a demographic section and asks for current name, age, home address, billing address, phone numbers, email address, employer, and insurance information. If there have been no changes in any of these areas, the patient can just write “same” on that part of the form.
Medical History Update – The second section asks questions about the patient's current medical status such as when he/she had last seen his/her physician, have there been any changes in his/her health status, are there any new medications or allergies. In addition, it asks about personal or family history of different diseases and conditions. It also opens the door for more verbal questioning by asking if any problems have developed since the last visit such as if the patient snores (possible sleep apnea). Lastly, it asks if the patient has taken required medication prior to the dental appointment.
Comments/Suggestions – The third section gives the patient the opportunity to tell you what he/she thinks about the practice. It asks if the patient feels that he/she and his/her family have been treated well and what is liked most about the visits. It then gives the patient the opportunity to indicate what he/she thinks could be done to improve the services of the practice. Lastly, it asks if the patient is happy with his/her smile. This section can open the door for productive exchanges with the patient both regarding the quality of the care and also what procedures might be suggested to "improve" that smile.
Payment commitment – The next suggestion is a reminder to the patient that payment is expected at that appointment. It states: “In an effort to reduce our billing costs so that we can keep our fees down, we require that:
Your fees or estimated copay/coinsurance be made on the day of your appointment


  It then states:
I will be paying today by:
The last section is where a patient signs to give the authorization for records to be released to the insurance company and also for assignment of benefits. This patient may have just become eligible for insurance benefits, so this form ensures that you have the required signatures.
The form ends with the statement that the practice thanks the patient for placing his or her trust in the care of the practice and mentions that the practice would be very grateful for referrals of family and friends.

Therefore, we have a form that helps the practice as a whole by being sure that all the right questions have been asked. The business office will know of any demographic changes and the form also helps to keep the accounts receivables in check due to the payment commitment section. The form also helps the clinical side of the practice determine if there have been any medical changes since the last visit and it alerts them to any current problems or concerns. Lastly, as a whole, the practice can see how well it's doing in the eyes of the patient and the form can become a marketing tool.

If you would like a copy of the Recare Update Form, please email me at and I would be happy to send it to you.

‘House codes’ further define varying degrees of periodontal therapy
Colleen Rutledge, RDH
Have you ever wished there were more codes to describe the services you provide? This segment will consider ‘house codes’ to further define varying degrees of periodontal therapy. Let’s consider the 2011/2012 CDT codes:
D4341 - Scale and root plane 4 or more teeth
D4342 - Scale and root plane 1 to 3 teeth
CDT D4341 describes the procedure when four or more teeth qualify for SRP perio therapy. However, this code does not reflect varying degrees of periodontal disease: early, moderate and severe. One can classify these degrees with associating the following letters - E: early, M: moderate and S: severe. Consider the diagram below*.

* Insurance companies do not consider anything past the first four numbers
* Fees are based on approximate national averages
Consider code D4342 in the same way. This code describes one to three teeth requiring SRP perio therapy. To better reflect various services provided within this code, one can classify these quadrant’s as ‘1’, ‘2’, and ‘3’ - based on how many teeth in each quadrant are involved. Consider the diagram below*

* Insurance companies do not consider anything past the first four numbers
* Fees are based on approximate national averages
This “tiering” of codes within D4341 / D4342 enables practices to associate fees which reflect the services provided. It also establishes a system for internal tracking of six different degrees of periodontal therapy procedures.
  Insurance Alert
Code D9110 Could this code be the forgotten code in your practice? D9910 is “palliative (emergency) treatment of dental pain minor procedure”. Quite often, when a dental practice treats a patient for a condition such as this, the coders seem to be at a loss to find a specific code that represents the actual treatment provided and may simply code it to D0140 (“limited oral evaluation established patient”). Using that code will perhaps eliminate one of the two oral evaluations that are usually paid by insurance companies each year, possibly presenting a problem at the next recare appointment. In addition, D9110 may have a higher benefit than D0140. So don't forget D9110.
Be very cautious with your choice of evaluation and management CPT codes. We in the dental field use codes that we refer to as exam codes but medical procedure codes (CPT) are referred to as evaluation and management codes. One major difference between this category of medical and dental codes is that medical insurance has levels to its new patient and established patient codes. The levels fall from a very basic problem focused visit (99201 for new patient and 99211 for established patient) to a highly complex and comprehensive visit (99205 for new patient and 99215 for established patient). Insurance carriers have established certain criteria that need to be met for the use of these codes which requires the evaluation of multiple body systems as you choose higher levels of the codes. Be very careful that you have performed the requirements for the code that you choose and you have the documentation to support that. If you would like more detail on the use of these codes, please contact me at
  Time Line
For those of you who have purchased my dental-medical cross coding manual, "CrossWalking A Guide Through the CrossWalk of Dental to Medical Coding", it is now past time to update the manual with the new, changed, and deleted diagnosis codes. Please be sure to email me at to obtain your update.
January 1, 2011 – CDT Code biennial update (If you haven't updated your practice management software codes, be sure to do it ASAP) (If you haven't gotten a copy of the new code-set, do that ASAP)
January 1, 2011 – Medical CPT Code (medical procedure codes) update (be sure to update your manuals and CPT codes that are entered in your software)
March 25 and 26, 2011Don't miss this opportunity for practices that deal with dental sleep medicine - The Dental Sleep Medicine Implementation & Team Training Seminar in Dallas, TX. Speakers will be Dr. Kent Smith, Dr. John Herald, Beth Thompson RDH, Ashley Truitt, Michelle Prince, and me (Marianne Harper).
For more information, contact me at:
or find a direct link on my website at:
July 5, 2011 – Medicare will require that all physician and non-physician practitioners that submit Medicare claims must be enrolled in PECOS (Provider Enrollment, Chain and Ownership System) as well as all ordering and referring practitioners, or claims may not be paid. Practitioners can enroll online at
October 3, 2013 – ICD-10 (medical diagnosis codes new revision)
January 1, 2014 – The date that the US government has chosen for requiring all medical and dental practices to be paperless

Favorite Quotes:
“At the beginning of any task, more than anything else, your attitude will affect its successful outcome.”
Jeffrey Gitomer, “Jeffrey Gitomer's Little Gold Book of Yes Attitude.”


Insurance audits If an individual arrives at your office and states that an insurance audit is the reason for the visit, there are several steps that need to be taken to protect your practice:

  1. Ask for identification there have been cases where individuals misrepresent themselves in order to get access to patient records (names, social security numbers, etc.)
  2. Be cordial to the individual and do not appear nervous. Don't give the person reason to be suspicious due to your reaction to his or her arrival.
  3. Do not leave the individual alone in an area where he/she has access to patient charts. You want to be sure that only a practice team member provides the requested charts.

Dental Humor:
A woman phoned her dentist when she received a huge bill. “I'm shocked!” she complained. “This is three times what you normally charge.” “Yes, I know,” said the dentist. “But you yelled so loud, you scared away two other patients.”

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The Art of Practice Management
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Perio-Therapeutics & Beyond
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