Oral Health In Your Office Welcome everyone and thank them ...€¦ · ICD 10 code – Z41.8 ......
26
Oral Health In Your Office
Oral Health In Your Office Welcome everyone and thank them ...€¦ · ICD 10 code – Z41.8 ... • Commercial carriers have no education requirement ... CME/CEU session . Important
Welcome everyone and thank them for taking time from their busy schedules to attend today’s presentation
Introductions
Presenter
Presentation Notes
Add your name. Briefly discuss your background and credentials. State the Dr. Chuipek is COHA and does FV in her office.
• We have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this activity.
• We do intend to discuss an “off label” use of a commercial product, fluoride varnish, that is currently approved for use as a cavity liner and tooth desensitization.
Disclosure Information
Presenter
Presentation Notes
Please briefly state that you have no financial relationships with any fluoride company or distributor. Fluoride varnish is only approved for desensitization but many studies reinforce use for caries prevention. Has been used in Europe and Canada for more than 25 years to prevent decay. Also used in US for over 10 years and is becoming the standard of care for fluoride treatments.
Support for this program is provided by grant funding awarded to PA AAP through:
● The Oral Health 2020 Initiative of the DentaQuest Foundation and
● The Pennsylvania Expanding Access to Oral Health Collaborative Project of the Health Resources and Services Administration (HRSA).
Healthy Teeth Healthy Children A Pennsylvania Medical/Dental Partnership
Presenter
Presentation Notes
Let audience know that DentaQuest Foundation has provided over 1 million dollars in grant money to Pennsylvania. They can find more about Oral Health 2020 by going to DentaQuest Foundation website. HRSA has also provided grant money to help improve oral health in Pennsylvania for both adults and children.
PENNSYLVANIA ORAL HEALTH COLLECTIVE IMPACT INITIATIVE
An Initiative supported by the
Pennsylvania Head Start Association
Presenter
Presentation Notes
HTHC is also part of the Pennsylvania Oral Health Collective Impact Initiative – a state-wide collaboration with the goal of improving oral health across PA.
✓Recognize the importance of oral health to overall health
✓Understand the role of fluoride varnish in a medical office
✓Have the necessary tools to encourage medical providers to implement a fluoride varnish program
✓Contact Healthy Teeth Healthy Children for an EPIC presentation
Learning Objectives At the conclusion of this presentation the participants will be
able to:
Presenter
Presentation Notes
Today we will meet these learning objectives
Why Oral Health in the Medical Office?
Presenter
Presentation Notes
So now we will discuss why is oral health important in the medical office.
1. Primary teeth are important! 2. Prevention works
Studies show a 30-60% reduction in caries with 2-4 fluoride treatments per year beginning within 6 months of first tooth eruption
3. Increases provider revenue with minimal burden
4. Cost effective healthcare
Why Bother?
Presenter
Presentation Notes
1. Primary teeth hold places for permanent teeth, contribute to speech development and are necessary for chewing and proper nutrition. Typically the last baby tooth is not lost until a child is between the ages of 12-13 years old! 2. Emphasize within 6 months of first tooth eruption. 3. Providers are “leaving money on the table” ! 4. Supports “health home” concept – cost effective health care since PCP is already looking into mouth. Takes only a minute or two longer to apply fluoride education can be done while talking with parents. All PA Medicaid/MCO and Commercial/Private insurance reimbursing in 2016! Private pay families may be willing to pay out of pocket
Why Medical Providers?
Children see medical providers for checkups
10X by the age of 2
An Opportunity: Medical providers can screen for dental decay, provide preventive treatments and oral health
messages during the child’s well visits
Presenter
Presentation Notes
Our mission is to integrate oral health into overall health. Children see medical providers 10 times by age 2 for checkups (every 3 months during the window when most kids get their first tooth). We want to capitalize on this opportunity.
US Preventive Services Task Force Recommendation
Current Recommendation Release Date: May 2014 • The USPSTF recommends that primary care clinicians
apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. Grade: B recommendation.
Presenter
Presentation Notes
USPSTF recommendation includes children through age five for FV, but insurance reimbursement varies (more information in upcoming slides)
ECC Prevention
Presenter
Presentation Notes
We do not want any child to have to suffer.. Caries can progress rapidly
Oral Health Screening
Presenter
Presentation Notes
When looking at the throat, very easy to screen the teeth. Options for application: knee-to-knee, sitting or lying down on exam table, in parent’s lap. Whatever works best for PCP!
Oral Screening/Risk Assessment is not designed to provide a definitive diagnosis
On the way to the tonsils, examine teeth and soft tissues for: • White Spots • Dark Spots • Ulcers
• Bleeding gums • Heavy Plaque • Unusual Lumps and Bumps
Oral screening helps to determine: • Anticipatory Guidance • Urgency of dental referral
Presenter
Presentation Notes
Oral screening by a medical provider is just being aware of differences, not diagnostic. The dentist has the time and knowledge to make a definitive diagnosis.
Fluoride A naturally occurring element
Presenter
Presentation Notes
Fluoride is a naturally occurring mineral found in soil, water, foods. Fluoridated water supply is the most studied public health intervention in history. Using topical FV in the office is easy and can take less than a minute. Show video.
How To Apply
Patient Education and Referral to a Dental Home
Presenter
Presentation Notes
As important as the topical fluoride application is the referral to a dental home. We don’t expect physicians to become dentist but to refer patients to the dentist at first tooth eruption. Earlier is better..
• First dental visit at 12 months (earlier if needed)
• Dental appointment within 2-4 weeks if: – White spots or tooth decay is observed – Child is at moderate to high risk for ECC – The first dental visit has not already occurred at age 1
• Immediate call to dentist if: – Brown spots or advanced progression of ECC is observed – A dental trauma/emergency is evident
Goals for Referral to a Dental Home
Presenter
Presentation Notes
HTHC will work with you to help find dental providers that accept MA and see kids at age one.
Making it Work for YOU
Presenter
Presentation Notes
During our hour long presentation we go over how to make it work for you. We share what other offices are doing and offer practical suggestions.
Payment
Coding and Reimbursement for Fluoride Varnish Application
• Both MCOs and commercial insurance providers are currently reimbursing for fluoride varnish application. Reimbursement rates: $18-$25+ per fluoride varnish application and
risk assessment from MCOs Reimbursement rates from commercial insurers vary widely and are
negotiated with practices individually First dollar coverage (with checkups), no copays or deductibles, can
be applied at any visit
• CPT Code 99188 - Application of topical fluoride varnish by a physician or other qualified health care professional (code used by both commercial insurance and Medicaid as of Sept 1, 2015)
• ICD-10 Code Z41.8 – Encounter for other procedures for purposes other than remedying health state (topical fluoride application) [change from ICD-9 – CM V07.31]
HTHC provides ongoing technical support for trained practices and can help troubleshoot any billing issues you may encounter.
Presenter
Presentation Notes
All private/commercial and Medicaid insurers are currently reimbursing for fluoride varnish application! RATES VARY! 2. CPT Codes - All using 99188 as of Sept 1, 2015 3. ICD 10 code – Z41.8 Requirement for MCO reimbursement is training/certified by Smiles for Life or HTHC! No RVUs have been set by CMS because Medicare does not cover dental related services. Please let your audience know that HTHC will provide technical support however the practice should always contact their provider reps first.
Coding and Reimbursement for Fluoride Varnish Application
MEDICAID
• Billed under physician, or NPs (only if in independent practice)
• Applied by MD/DO, PA, CRNP, RN* *If direct application of medicaments is determined in scope of work
• Training required
HTHC EPIC Oral Health in Your Office
Smiles for Life – Module 6 www.smilesforlifeoralhealth.org
• Age limit < 5 years old
• Requires risk assessment
COMMERCIAL
• Billed under physician, or NPs (only if in independent practice)
• Applied by MD/DO, PA, CRNP
• NO training required
• Age limit < 6 years old
• Does not require risk assessment
**BOTH Medicaid and Commercial insurers cover up to 4 applications per calendar year (every 3 months) for moderate to high risk
Presenter
Presentation Notes
Application: For Medicaid, any trained medical professional within whose scope of practice such application of medicaments is allowed (including PA, CRNP, or RN in addition to the physician) can apply fluoride varnish, but it must be billed under the physician. More information re: RNs, per Paul Westerberg - As with other health services and procedures that may be appropriately delegated by physicians to supporting staff, the direct application may be performed by those staff within whose scope of practice such application of medicaments is allowed. In the original investigation of such scopes of practice, we vetted that PAs, CRNPS, and RNs did possess that level of scope. For private insurers, fluoride varnish can be applied by a physician, CRNP or PA (though again billed under the physician). Risk: Any child who uses/used a sippy cup is moderate risk and FV application can take place at any visit! Age Limits: Note that while the USPSTF recommend TFV application for children up to 6 years of age, Medicaid limits to children under 5 years of age.
• Fluoride Varnish application is in Bright Futures and USPSTF recommendations for checkups from first tooth to 6 years old.
• Medicaid requires either Smiles For Life or Healthy Teeth Healthy Children education
• Commercial carriers have no education requirement
• HTHC will go to any office in Pennsylvania to demonstrate how to apply fluoride varnish in a one hour CME/CEU session
Important Pearls
Presenter
Presentation Notes
Here are some other important items that may be helpful. Bright Futures is the prevention and health promotion guidelines from the American Academy of Pediatrics.
In Office Presentation Benefits
• Hands on Fluoride Varnish Demonstration • Detailed Reimbursement Information • Ongoing technical support from HTHC • DHS Paperwork Completed
Educating Providers
HTHC will provide
• Scripts for provider reps • Answers to questions • Promotional literature • Ongoing assistance to HPP and providers
