2.16.07 - Issue # 258 Forward This Newsletter To A Colleague

Belle DuCharme CDPMA
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Is Your Dental Treatment Justifiable?

“4.c.1 Meaning of “Justifiable” from the American Dental Association’s Principals of Ethics and Code of Professional Conduct—revised 10-06

“Patients are dependent on the expertise of dentists to know their oral health status.  Therefore, when informing a patient of the status of his or her oral health, the dentist should exercise care that the comments made are truthful, informed and justifiable.  This may involve consultation with the previous treating dentist(s), in accordance with applicable law, to determine under what circumstances and conditions the treatment was performed.   Difference of opinion as to preferred treatment should not be communicated to the patient in a manner, which would unjustly imply mistreatment.  There will necessarily be cases where it will be difficult to determine whether the comments made are justifiable.  Therefore, this section is phrased to address the discretion of dentists and advises against unknowing or unjustifiable disparaging statements against another dentist. However, it should be noted that, where comments are made which are not supportable and therefore unjustifiable, such comments can be the basis for the institution of a disciplinary proceeding against the dentist making such statements”

Working with client Dr. Goodfloss (not his name), he received a call from an upset patient stating that “I have reported Dr. Goodfloss to my dental insurance company so that I can get my money back because Dr. Badbreath (patient’s new dentist) said that Dr. Goodfloss did not place a crown on tooth #3, but the insurance paid him for it three years ago.  Dr. Badbreath needs to be paid for his new crown, so please give us our money back!”  The patient was told that we would need to research the information and return the call within the next hour.  It would have been professional of Dr. Badbreath to call to consult with Dr. Goodfloss before the patient’s frantic call was received.

Upon examination of the record and the lab slip, it was determined that a cast porcelain onlay was placed on tooth #3 three years ago.  The patient’s insurance company had paid the contracted amount for the onlay (a crown had not been billed).  The patient had not returned to Dr. Goodfloss in the last three years so there was no record after that as to the condition of the onlay.  A copy of the lab slip, x-rays, chart notes and statement of account were sent to the patient so that he could communicate the information to Dr. Badbreath.  Dr. Goodfloss never received a call from Dr. Badbreath.  The patient was put in the middle and the entire situation was preventable.  Dr. Goodfloss had accurate records with supporting data.

Accurate documentation of patient records is of utmost importance.  The entries need to be detailed including all anesthetics (dosage), description of treatment on each tooth, materials, shades, cement types, labs used, x-rays, photos, patient comments.  Copies of lab slips need to be scanned or placed in records.  Charting existing restorations routinely on every new patient will give you the base to work from for creating a new treatment plan.  Charting these existing restorations should not be done solely from x-rays that a patient brings to you from another practice because they may have had some work after the x-rays were taken and some restorations are hard to distinguish in the x-ray and need visual viewing to make an accurate observation.  Notes on the patient’s experience with past dental care should be documented along with the patient’s primary reason for seeking care in your practice. Meticulous noting of periodontal conditions with charting that includes BOP, recession, mobility, gingival attachment etc is important especially if you embark on a course of periodontal therapy that was not diagnosed at a previous dental practice. 

When requesting records from the patient’s previous dentist I recommend x-rays, perio chart and clinical notes (if the patient has received any major treatment) are sent.  If there were record that the patient was seeing a specialist for any condition, I would also request records or a current report from the specialist as to the condition of the patient prior to their arrival in your office.  Checking insurance history with the insurance company helps determine if a claim was filed on a proposed course of treatment in the past.

Does this seem like a lot of work?  When you consider the possible consequences of inaccurate records… I think not. 

I hear over and over again how difficult it is to find formally trained dental personnel for front office positions.  This “gatekeeper” job is the most important for the growth and maintenance of the systems of your practice.  This person is the last team member to view clinical information and is your check and balance for accuracy of insurance claims, treatment planning, communication with labs etc.  If he/she does not have the knowledge to complete these tasks you are asking for chaos, incomplete or inaccurate records and claim filing, billing problems, scheduling errors and patient attrition.

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