D0006 JUNIOR CLINIC

Chart corrections before and during clinic.The D0006 code is for chart corrections and determining

proper treatment for patients transferred from another student.

A D0120 recall examination is when the patient of record has not been seen for more than a year and needs a full exam,

along with possible radiographs.Next Slide

6.24.2019VBH

Purpose of the D0006■ Overall to make sure the actual patient and Axium record

are in agreement, and that treatment can proceed.■ Perform chart corrections (“chart hygiene”) to rid chart of

errors, duplications, or previously completed codes. ■ Identify codes to be corrected by the faculty under their

faculty log-in (deletions, corrections).■ Prepare the patient and record to continue comprehensive

treatment planning and treatment, and build trust.■ NOTE: You may only need a D0006. In some cases, you may need a D0120 or D0150 in

addition to the D0006. All transfer patients need at least a D0006.

Next Slide

What do all these codes mean?

Explanation of CodesD000X are DCG internal codes for the school to use. They have no charge but are used for tracking

■ D0001 = Assist■ D0002 = Surgical assist■ D0003 = Dept Case Complete■ D0004 = Senior case■ D0005 = Patient Tx Complete■ D0006 = Active encounter■ D0007 = Screening: Panoramic film■ D0009 = Screening: Intraoral full series

D0XXX are ADA codes you would use in practice. Most incur a charge to the patient ($) vs. NC (no charge)■ D0120: Periodic oral exam $■ D0150: Comprehensive Oral exam $■ D0010: Intertreatment radiograph NC■ D0274: BWX $■ D0220: PA $■ D0230: PA additional $■ D0140: Limited oral eval: problem $■ D0171: Re-eval Post Op visit NC■ D0170: Re-eval: limited problem focus $■ D0191: Assessment of patient NC

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Evaluate the radiograph statusThis should be done before clinic

■ Are there any existing radiographs that have notbeen approved (they would have a red triangle in the top corner, and the name of the series would be in red)?

Yes

No

These have approval

Approval of radiographs■ It does not matter if you

did not take the unapproved radiographs. They must be approved that day by the supervising faculty. Have this approval done at the beginning of the appointment.

■ Write this need down for the D0006 appointment.

■ WHY?■ Because if you make new

radiographs, they can be incorporated in the template with the old (unapproved) ones and the dates will not be correct.

■ Also, they will then be accessible anywhere else in the building.Next

Slide

Unapproved radiograph problem■ This patient had an

implant x-ray made 5.15.19 when unapproved x-rays existed.

■ The implant x-ray went into a previous unapproved BW template, so the implant film and other PA films cannot be found in the listing by date or by name.

5.15.19

5.6.195.6.192.19.19

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Determining if more radiographs are needed

■ When were the last radiographs made?

■ Has any treatment been performed since that time?

■ How extensive has the recent treatment been?

■ Are there treatment plans for crowning any teeth?

■ Any endodontically treated teeth?

■ Any need to monitor bone levels on implants or for patients who had periodontal therapy?

■ Are the radiographs diagnostic quality?

■ MAKE WRITTEN NOTES FOR THE CLINICAL APPOINTMENT

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In-Progress Tab

■ Check the “In Progress” tab on the left of the EHR tab.

■ Scroll through the bottom panel to see all codes and teeth numbers.

■ The panel can be enlarged for viewing using the button on the right side.

■ Look in the bottom panel. Are there any items in black?

Yes No

In-Progress Tab (continued):Codes and Teeth

■ Make a written list of all the treatment items and codes in the bottom panel that are “Planned” or “In Progress”.

■ When in the clinic, use a golf pencil and disposable sheet of paper for your list(s).

■ You will use this list in clinic to determine whether this entry is an error or correct.

■ This list will also be a reminder to check those items for duplication. Next

slide

Accuracy of “In Progress” Tab■ If there were items “In

Progress”, you need to return to the EHR Tx History to determine if they are valid.

■ Sort the Tx History by “site” and find those tooth numbers and codes that are “In Progress”.

■ Are there any duplications of the same treatment on one tooth where one is completed and one is planned or in progress?

Yes No

Correction of Duplications■ If you found

duplications on one tooth, make a written note to check the patient clinically and show your duplications list to the faculty.

Clinically: Evaluate the tooth in question to see what has been done.The faculty would have to log in under their name (Tools-Switch User) to delete the error. They may add a note to the D code to explain why the code was deleted.

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Corrections of Omissions■ Are there any codes

that are planned that were not duplications?

■ Make a written note to check the patient clinically to see if that procedure needs to be done.

■ These codes might include treatments that were performed by an outside dentist,

■ Or treatments performed on the state licensure board.

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End of Pre-Clinical check list; now for the Clinical examination

■ Obtain starting check. ■ Get approval of any

unapproved x-rays.■ Update the medical history

tab, vitals, head & neck exam, and dental exam.

■ Update CRA and PSR.■ Ask the patient if any

treatment performed outside the school since the last appointment.

■ Ask the patient if any treatment was performed on a state board examination.

Next slide

Wait! I want to go back and look at the other options

on the “In Progress” tab

Clinical Examination■ Examine each tooth for

existing restorations and/or possible problems, and list them on paper by tooth number.

■ Determine if the odontogram matches the patient’s current condition. Make written notes to discuss with the faculty.

■ Evaluate the pre-clinical lists you made with the patient.

■ Have faculty evaluate and make decision about whether additional radiographs are needed.

■ If more x-rays are indicated, add an x-ray code to the record. Next

slide

Clinically: Are New X-rays needed?■ What was the date of

the last radiographs?■ Has treatment been

performed since that time, either in DCG or outside?

■ Are the radiographs diagnostic quality?

■ What are your clinical findings?

■ Crowns or implants planned?

■ Determine if you need new radiographs that incur a charge (BWX or PA) due to elapsed time, and use that code.

■ Determine if you need to update a few radiographs without additional charges, use the D0010 code (Inter-treatment radiographs).

YES

No

Radiographic Template Choices■ To avoid having to

approve each radiograph one-by-one, either use the FMX template, or the BWX 2, 4, 7, or 9 template.

■ What if I get an error message and no approval?

■ When you save the radiographs, name the radiographs correct (not using the template name).

■ Name them for what they represent, such as “PA #14”, or “BWX 2”.

■ Keep the names short so they are not hidden in the left column.

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Error msg

Error on radiographic approval■ If you get an error, use the

“description” drop-down on the left to identify the region and approve the radiographs one by one.

■ The “regions” are not in alphabetical order, so you have to hunt for each area related to that radiograph and select.

■ Then approve each x-ray, and the red triangle in the top left corner will disappear

Un-approved Approved

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Radiographic Interpretation in the chart

■ For a few radiographs, use the short form to interpret.

■ Add treatment note.■ Select the ellipsis

(three dots in the box).

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Radiograph Interpretation (continued)1. Select the “Diagnostic Sciences” line and expand.

2. Select the “Radiograph taken…” entry, then click the down arrow, then OK.

3. The text template is inserted in the chart. Start by editing the first line and complete the others.

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Faculty Review (Odontogram & Proposed Treatment Plan)

■ Once you have current radiographs and have re-examined the patient, write notes on paper for proposed changes to the odontogram and treatment plan.

■ Faculty should perform a clinical exam, confirm proposed odontogramchanges, and review proposed treatment.

■ Create the desired treatment plan from the faculty discussion, have the faculty approve it, then have the patient sign it.

Nextslide

Wait! I want to go back and

review the x-ray info.

Create the New Treatment Plan■ RULE: You cannot add

to an existing approved plan that has been signed by the patient.

■ What if the treatment plan is faculty-approved but not patient-signed?

■ Is there new treatment identified by the clinical exam that needs to be added?

OPTIONS FOR TX: ■ BEST: Make a single

comprehensive treatment plan, get faculty approval and patent consent, then delete all the remaining treatment from old plan(s) using the “In Progress” panel .

■ OCCASIONAL: Make a new treatment plan that compliments the existing treatment, but does not duplicate it.

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How to edit

How to edit a faculty-approved (green) treatment plan

■ When the plan is approved by the faculty it will be GREEN.

■ Right click on a treatment line

■ Click “reopen option”, then answer yes.

■ The treatment plan should then turn BLUE, and is back into the DRAFT stage for editing.

■ IF the treatment plan had been BLACK, that means it is sign by the patient and cannot be changed or treatment added. Return

End of Appointment Reminders■ Treatment plan is

signed by patient after faculty approval.

■ Complete codes for that day (some may have to approved in planned stage first).

■ Make odontogramcorrections.

■ Attach a note to eachcode used.

■ Approve new radiographs by faculty.

■ Attach radiograph interpretation to new radiographs using short note format in chart.

■ Faculty approve all codes and notes.

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Questions before we finish?

■ What about planned treatment entries that have other student’s name on them?

■ What about patients who need multiple treatment plan options (fixed, implant, removable, etc.)?

■ What if I have a referral entered by a previous student that I need to delete (in Blue)?

■ What about planned entries that are in blue ink?

■ When can I “chart add” and when do I need a “new treatment plan”?

■ I don’t have any further questions.

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Faculty removal of inappropriate or redundant Axium codes

■ Refer to your lists from the odontogram review and the clinical exam.

■ Have faculty log in under their name (Tools – Switch User).

■ Open the “In Progress” tab and enlarge view.

■ In the “Pending Treatments” panel, delete any inappropriate or redundant codes.

■ In the same panel, right click to add a note to the deleted code to explain why it was deleted.

■ Use “Tools-Switch User” to return back to the student log-in. Next

slide

Summary of D0006 Visit

•All approved?•Date of last films?X-ray status •Remaining treatment to be done?•Duplications or Omissions?In Progress Tab•Duplications on same tooth number•Omissions do not correlate with patientSort by site•Teeth status (odontogram)•X-rays neededClinical Exam

END or go Back to the

BeginningReturn to Questions

Wait! I want to go back and review the x-

ray info.

Existing Treatment without my name?

■ If there is needed treatment under another student’s name, do I delete it?

■ NO: When you start that treatment (put “In Progress” or “Complete”), your name will replace the previous student’s name.

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Blue or Black entries in the record

■ Items in black ink have been approved by faculty.

■ Items in blue ink have only been entered by students, and need faculty approval.

■ If you open a “black” planned entry and then close it, it will have to be approved again as planned.

■ Do not “chart add” treatment.

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Multiple Treatment Plan options■ Depending on the

complexity of treatment options, you may need to create several “draft” treatment plans.

■ Each treatment plan should be a ”complete” plan so the patient can see the costs and procedures.

■ Have faculty review treatment plan(s) and agree with patient on planned treatment.

■ Faculty approve that treatment plan and patient signs.

Return to Questions

Chart Add vs. New Treatment Plan

■ Chart Add: Only used for diagnostic treatments such as examinations, radiographs, and prophylaxis.

■ Treatment Plan required:

To obtain consent of patient for all other treatment, even if no charge (such as LOA).

Return to Questions

Referral from another student (in BLUE) than needs to be deleted

■ Click to open the referral & click the “Approval” box.

■ On the Approval screen, click “DENY”.

■ You will be asked again to be sure, so click “YES” and then swipe.

■ The Approval screen will re-open. Select “Cancel”.

■ Referral should be deleted.

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