WINNER! National Dentist's Day Giveaway
THANK YOU to everyone who entered! The winner is:
Congratulations Stephanie! Email us @ hygieneedge@gmail.com with your mailing address.
PART 1-How To Increase Production-With Radiographs
I often get asked the question, “How can I increase the hygiene departments production?” There are two main reasons why this being asked. The first being that the hygienist is being told that they don’t produce enough. Second, because you work on commission and you would like to earn what you are worth. In both of these scenarios you HAVE to find a balance between sales and improving oral health to keep yourself happy and motivated.
I often get asked the question, “How can I increase the hygiene departments production?” There are two main reasons why this being asked. The first being that the hygienist is being told that they don’t produce enough. Second, because you work on commission and you would like to earn what you are worth. In both of these scenarios you HAVE to find a balance between sales and improving oral health to keep yourself happy and motivated.
I daily ask myself the question while reviewing my charts, “How can I help my patients today?” If you can provide high quality care, the finances will come. What do I mean by “high quality?” I mean the basic, evidence based, standard of care services. That's what increases production.
I will start part one of this series discussing radiograph production. Each morning, I would recommend looking through your charts with the dentist and getting a “prescription” for each patient if they need radiographs or not based on need.
BWX- According to the ADA’s Dental Radiograph Exam document, patients who are at high caries and periodontitis risk may need radiographs every 6 months vs 1 year. Some offices just give a generalized 1 time per year exposure but some patients need them earlier to catch problems while small. Even if BWX's are not covered by insurance, the patient must be informed they are at increased risk for these concerns and that we can catch things when small, which saves finances and precious tooth structure. This is giving your patient proper care and increases production.
NOTE: If your patient doesn’t have coverage for BWX, but based on their risk assessment, they need them, you need to word your recommendation in a certain way to get them to accept the necessary and needed treatment. For example:
Correct way- “Dr. Jo has reviewed your chart and is concerned that you are at a high risk for cavities. He would like to me to take 4 x-rays of your teeth today to check for cavities and it will also evaluate the health of your bone. This can help us to prevent future concerns. The cost will be $52. Can I go ahead and take those for the Dr.?
Wrong way- You need 4 bitewings, it will be an extra $52. Do you want them?
PANO- I am always amazed at how many offices I have worked in that don’t update the FMX or Pano every 3-5 years, especially since insurance usually covers it within that time frame at 100%. Whether the patient has insurance or not, the standard of care is that patients need one FMX or Pano every 3-5 years to catch things we would not see in the BWX. I understand that time is sometimes scarce, but plan ahead and schedule an extra 10 minutes at the next maintenance care appointment if needed. If one has NEVER been taken, you could be held liable. When you do this, you are helping your patient prevent potential issues and increasing production.
Have you noticed that I keep saying the phrase “this will help your patient, and increase production.” I have to remind myself of that daily as I recommend necessary treatment. Therefore, I am going to keep reminding you as well.
PERIAPICAL RADIOGRAPHS: At the beginning of the appointment, be sure to determine the patient's chief concerns. If they mention that they are in pain, snap a PA for evaluation of the root for the dentist. Also, we check the posterior teeth with BWX, but how often are you checking the anterior teeth? I have found that many offices perform a risk assessment and determine, based on patient needs, that 2-6 anterior PA’s are indicated (number varies per dentist's prescription.) Consider as well that often times an evaluation of teeth with root canals or implants are necessary before another FMX/Pano is indicated and the dentist may prescribe a PA evaluation of the area. Another indicator for a PA is if a crown is ever diagnosed, a PA of the area must be taken for insurance coverage. To increase production, I will take one after a crown is diagnosed. All of these needed scenarios help the patient and increases production.
If you want more information on how to determine if a patient needs radiographs visit the ADA’s report called DENTAL RADIOGRAPHIC EXAMINATIONS: RECOMMENDATIONS FOR PATIENT SELECTION AND LIMITING RADIATION EXPOSURE.
GIVEAWAY- National Dentist Day
Happy National Dentist Day (yesterday)!!
We all know and love many dentists. We want to help celebrate these professionals in our life! We are giveaway two tooth pins from our shop- one for you and one for your dentist!
To enter, just comment below where you currently practice. For an extra entry, let us know what you love about the dentist you work with!
Fluoride Varnish Post Op Handout
Ever wonder if your patients follow your post op instructions? Now you don't have to with our Fluoride Varnish Post Op Instructions printout.
After a long appointment, the last thing your patient will remember is the post op instructions for the fluoride varnish you just placed. Don't even get us started on what kids hear! Instead of wondering if they are actually following your recommendations, print off our FREE Fluoride Varnish post op instructions and put them in your patient's take home bag. Now they will have something tangible to follow and the varnish will have time to be effective!
Download the PDF version here.
Have You Lost "Your Grip?"
Do you find yourself complaining of hand, wrist, or lower arm pain? It could be because you've “lost your grip.” You may have let your hand slip into the usual way you hold a pen and let some fingers take a vacation in their grasp duties. The way that we usually hold a pen is unsuitable for use by dental professionals to hold their instruments. This is because the way we hold a pen to write requires increased force of the muscles of the hand and upper arm. Stability and flexibility of this type of grip are low as a consequence of using the middle finger for both holding the instrument and supporting the hand.
As we hold a pen when we write, the third finger is fixed. Therefore, many movements have to be made in the wrist. This causes unfavorable positions such as an extensive palmar flexion. It is understandable that the use of a normal pen grip can give rise to "CANS" (complaints of arms, neck and shoulders), formerly called RSI (repetitive strain injury). Did you know that you get FOUR times the strength when you use a modified pen grasp when instrumenting?!? You DO, as well as less discomfort in you hand, wrist and arm.
When my students complain about hand or arm pain, I look first to their grasp. When my students complain about ineffective calculus removal, I look first to their grasp. I often see fingers taking a vacation, being lazy or taking on the duties that another finger is supposed to perform. Let’s review the duties of each of the fingers:
The thumb and the index finger are used to sandwich the instrument. They are responsible for holding the instrument steady and providing the rolling function of the instrument in adaptation.
The middle finger is the feeler finger to help assess calculus deposits.
The ring finger is your fulcrum, powerhouse and stabilizer.
The pinky is a freeloader, no other finger can have the job of the freeloader because the pinky has the job covered.
The most common mistake I see is that the feeler finger takes the job of the pointer finger, which I have seen decreases effectiveness in assessment and in calculus removal. Remember to get a grip and to use the modified pen grasp to help your body and your practice.
Watch our demonstration of correct grasp below.
What Code To Use When Patients Have Heavy Calculus But No Periodontitis
We have all been in a situation when a patient has bucket loads of calculus but doesn’t present with periodontitis. It has been 3+ years since they have had any dental care and you know you will need more than the average 20 minutes to complete the treatment. There is really no dental code for this situation, so below are some options for care. Decide what is best for your office and make a plan to get everyone on board so that when the situation comes up, it will be a smooth transition.
OPTION 1:
When to use: Use option 1 if you need more than one visit to complete treatment.
Bill the prophy code D1110 and complete the right side of the mouth. Then at the second appointment charge another D1110 for the left side.
Pro:
1. If the insurance covers D1110 twice per year any time. The patient gets full coverage of cleaning the entire mouth.
Con’s:
1. At their 6 month check up, the next prophy would have to be paid out of pocket depending on the time of year they came into see you.
2. Some insurances will only cover the D1110 exactly 6 months and 1 day apart. If this is the case, the patient must be informed that the second prophy will be paid out of pocket.
Special note: If you start with the right side, the patient will notice an annoying difference with their tongue on each side and will want to return for care of the left side.
How to present the treatment plan: "After assessing the health of your mouth, I have noticed that you have generalized gingivitis with a heavy amount of build up on your teeth. If we leave the build up there, it may quickly turn into a more serious disease called periodontitis. Since it has been such a long time that you have had treatment, I am going to need more time to complete your treatment. I recommend that we clean the left side of your mouth today and then schedule you back for one more 30 min visit to do the right side. Here is what the cost will be…...
Treatment plan:
APT 1: D1110 - $64-$100 covered at 100% by your insurance
APT 2: D1110 - $64- $100 out of pocket expense
Option 2:
When to use: Use option 2 if you have extra time in the schedule to complete all of the treatment in the same day but you will be taking more time than just the average 20 minute prophy time.
Charge D1110 and then bill D1999 (and unspecified preventive procedure) for the extra time you took to complete the treatment.
For example every 5 minutes extra you use you could charge $10. So if you take an extra 15 minutes to complete the treatment you would charge the patient $30.
How to present the treatment plan: "After assessing the health of your mouth, I have noticed that you have generalized gingivitis with a heavy amount of build up on your teeth. If we leave the build up there, it may quickly turn into a more serious disease called periodontitis. Since it has been such a long time that you have had treatment, I am going to need more time to complete your treatment. Luckily, we are running ahead of schedule and I can complete it all today. Here is what the cost will be…...
Treatment plan:
APT 1: D1110 - $64 covered at 100% by your insurance and D1999-$30 for the heavy buildup removal.
OPTION 3:
When to use: Use option 3 if you can’t see to do a proper exam because there is too much calculus or biofilm. The patient should be rescheduled for an assessment to determine if periodontal therapy or a prophy is needed.
Charge D4355 (Full mouth debridement) IF you can justify that a proper exam cannot be completed unless the biofilm and heavy buildup is removed first.
Then in 1-2 weeks, perform a follow up assessment and D1110 (prophylaxis).
Pro:
The patient gets full coverage from insurance of care for the dental treatment.
Con’s:
The D4355 code states, “the gross removal of plaque and calculus that interfere with the ability of the dentist to perform a comprehensive oral evaluation. This preliminary procedure does not preclude the need for additional procedures.”
Therefore you must be able to justify, and state in your notes, that a comprehensive exam cannot be performed based on the amount of calculus and biofilm present.
2. Removing just the gross debris leaves a risk for periodontal abscess and a potential of the patient thinking that they are “clean” and not return for the rest of the care. That is why this code should be used only in rare cases.
How to present the treatment plan: "After assessing the health of your mouth, I have noticed that you a heavy amount of build up on your teeth. Due to the amount of build up, I will need to remove some of it for the dentist to do a proper exam. Then I will need to see you in 1 week to re-evaluate the health of your gingiva and teeth. Here is what the cost will be…"
Treatment plan:
VISIT 1: D4355 - $64 covered at 80% by your insurance.
VISIT 2: Re-evaluation of periodontal health with new treatment plan presented.
Want more help with codes and billing. Check out our 1 page guide to billing and coding for hygienists in our store. On sale now.