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  10.29.04 Issue #138

Record Audits - Reading the Tea Leaves or Tracking the Numbers

Sally Mckenzie, CEO
McKenzie Management

       Ignorance is indeed bliss. And few things could be more blissful than the undocumented belief your files are packed all fat and happy with thousands of active patient charts. Dentists have a tendency to be oblivious to the number of patients that have left the practice. They see all those records lined up in all those cabinets and it’s just like hot soup on a cold day – warm and comforting – they feel totally assured that unlike those other practices, their patients are loyal.

However, the only real means of assessing true patient loyalty is to conduct an annual record

audit to ascertain just exactly how many patients continue to choose you as their dentist. What? Is that a protest I hear? “But we don’t have time to do chart audits. Our patient retention must be fine because we are so busy we are only allowed to schedule vacations during years in which a solar eclipse can be seen in North America.”

Busy is often an illusion. It’s commonly the clever disguise of a dwindling patient base, and it will fool nearly every practitioner from here to the sun. Audit the charts and review the key computer reports, including the past due recall report, the missed appointments report, and the unscheduled treatment report. This puts you in the position of being proactive rather than reactive to the ebb and flow of your patient base. Start by making the most of the information that is right at your fingertips. Here’s how.

  1. Generate a report of patients due for recall from today’s date to one year from today. Indicate that you are seeking to identify all patients with and without appointments on the report.
  2. Count the number of charts in the file and divide that by the number of patients on the recall system. For example, if there are 4,759 patient records on file and 1,737 patients in the recall system. Patient retention would be at 36%.
  3. Now subtract the number of active patients from the number of total patient records in the files. Using the example above that number would be 3022.
  4. Divide that number by the number of months the charts represent. For example, if you believe that active charts represent the period from 5/01 through 9/04 that would be 39 months. In this scenario, the practice is losing 78 patients per month.

You can also look specifically at recall over the last year. For example, if this is 10/04, generate a report of patients due for recall with and without appointments from 1/04 through 9/30/04 and divide by nine months. If the total number of patients on the report is 850 divide that by 9. This would indicate a patient loss of 94 patients per month. Obviously the patient base is shrinking. Now what?

Take action today.

Reconnect with those inactive patients. Assign a patient coordinator to:

  • Make a certain number of calls to past due patients each day.
  • Schedule a specific number of appointments.
  • Track patient treatment to ensure a certain number of complete treatments.
  • Schedule so the hygienist achieves a daily or monthly financial goal.
  • Manage the unscheduled time units in the hygiene schedule.
  • Monitor and report on recall monthly during the staff meetings.

Reacquaint yourself and your practice with patients. Send a direct mail letter to every adult in your active and inactive files who is or was a patient in good standing. Be sure to include something about the importance of ongoing professional dental care and giving patients beautiful smiles.

While a variety of practice systems likely need to be examined to determine exactly what is causing patients to seek care elsewhere, you can take at least a few immediate steps to slow if not stop the exodus.

If you have any questions or comments, please email Sally McKenzie at

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The New Periodontal CDT

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

          The 2005 current dental terminology edition is now available. The greatest number of revisions in the code is in the periodontal section. The major changes in the non-surgical periodontal service area are D4355 (full mouth debridement), D43481 (localized delivery of antimicrobial agents), and D4910 (periodontal maintenance). These revisions can play a significant role in the treatment protocol you institute.

“What code do I use to report a cleaning in the presence of inflammation?”

“The descriptors of the prophylaxis codes (“D1110 prophylaxis-adult” and “D1120 prophylaxis child”) include removal of factors that cause local irritations. When bone loss is present, other procedures may be appropriate to control disease factors.”

The definition of gingivitis in the 2005 edition is: inflammation of gingival tissue without the loss of connective tissue. So, is inflamed gingiva healthy tissue or gingivitis? What is really being discussed is gingivitis and it being treated with prophylaxis. A prophylaxis may or may not correct the problem depending on many factors including underlying systemic disease, undetected subgingival calculus, bone loss, or poor restorations. It is important to reevaluate the reduction of the inflammation after whatever appropriate treatment is instituted. Most dental offices tend to over treat with prophylaxis which “is intended to control local irritational factors”. The dental profession needs to develop a better protocol to treat gingivitis.

In the meantime, this is the perfect situation for D4355 (full mouth debridement). D4355 is defined as “The gross removal of plaque and calculus that interferes with the ability of the dentist to perform a comprehensive oral evaluation. This preliminary procedure does not preclude the need for additional procedures.”

When there is bleeding with or without the presence of supragingival calculus, the appropriate therapy is to remove the plaque by gross debridement, which may be the possible source of the inflammation. Include home care instruction, anti-bacterial oral rinse and dentifrice to remove the biofilm. Have the patient return in two or three weeks for a follow up evaluation. If the inflammation is under control and gingival health is within normal limits, perform the prophylaxis. If the inflammation is still present, other procedures may be necessary such as: periodontal examination with scaling and root planning or periodontal surgery as indicated, reshaping or replacing existing restorations, systemic disease workup, and medication evaluation.

The next question is when do we utilize a recall interval with prophylaxis or periodontal maintenance? The revised D4910 (periodontal maintenance) code states, “This procedure is instituted following periodontal therapy (scaling and root planning and/or periodontal surgery) and continues at varying intervals, determined by the clinical evaluation by the dentist, for the life of the dentition or any implant replacements. It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planning where indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.

It is important to note that the dentist determines the recall interval for periodontal maintenance. Once periodontal therapy is instituted periodontal maintenance is for the life of the patient. However, if the treating dentist determines that a patient’s oral condition can be treated with a routine prophylaxis, delivery of this service and reporting with code D1110 may be appropriate. Understand that once you have determined the patient requires only a prophylaxis you will need to justify a return to a periodontal maintenance procedure. Periodontal maintenance is more involved than a prophylaxis and deserves an appropriate fee. Also, examinations and other diagnostic procedures are no longer included as part of the periodontal maintenance procedure and may be performed on the same visit using the appropriate diagnostic codes.

D4381 (localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue per tooth by report) has been broadened to include all FDA approved subgingival delivery devices containing antimicrobial medication(s) released for a sufficient length of time. Note the report is by tooth not quadrant.

Review your protocol based on these new definitions. Explain to your patients requiring periodontal therapy that maintenance is an integral part of the therapy. They must understand that periodontal maintenance is more involved then “just another cleaning” and requires more frequent intervals once the periodontal procedures have been completed. This will help avoid the problem of the patient not valuing the periodontal maintenance visit.

If you have any questions concerning your hygiene program submit them to me at and I will answer them in future articles.

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“I must Create a System or be enslaved by another Man’s.” - William Blake

Belle M. DuCharme
RDA, CDPMA, Director
The Center for
Dental Career Development

          Having the “right”…the “best” computer software and hardware package is one of the most important factors in the success of the dental practice not only for today but where it will help take you tomorrow. Doing the research necessary to make the “right” decision for you may take some time and effort but will cause less stress in the future. Price may be a factor for you now but remember if the practice is to grow… the software and hardware must be able to expand with the growth of your practice. Make sure if you are buying software and hardware from different sources that the hardware meets

or exceeds the software specifications and can integrate well with the programs.

Here is a check list to follow when choosing the “right” computer for you:

  1. Check to see if the company from which you are purchasing has been in business long enough to establish a list of happy customers that you can contact for information about the system. Talk to doctors with established practices to learn of their successes and failures.
  2. Attend at least three demo sessions of different vendors. Remember that each company would like you to buy their system so keep focused on the needs of your practice.
  3. Pay attention to the areas that will affect the time management of your practice.
  4. Clinical charting should have an area for unlimited notes.
  5. Treatment planning should be easy to access and used by the clinical assistant.
  6. Perio charting should be user friendly and easy for both hygienist and dental assistant to navigate.
  7. The recall or recare system should be able to print reports showing the status of all active patients. When the patients are due, at what interval, if they are appointed or not appointed is important information.
  8. You should be able to print an overdue recall report and an unscheduled treatment report.
  9. You should be able to print an overdue insurance report with information to contact each insurance company.

Many doctors and their staff are trained on just the basics of their software systems. Insecurities in regard to computer software systems keep many offices doing double entry. They enter information on a paper chart and in the computer leading to incomplete records and time management issues. I have seen many offices reject the e-claims in favor of printing insurance claims to paper and sending. Preventive services sent by e-claim have a turn around of a week to two weeks. Preventive services by “snail” mail typically have a turn around of up to 30 to 40 days. You can see how this affects cash flow.

My advice is to learn the system and keep updating it. Monthly “lunch and learn” training sessions on the computer can be a matter of routine in every office. Take the time to call support. Have a list of all questions to be answered.

Make sure you have a fail proof back-up system and the tapes are stored offsite in a secure location. Backing up at lunch and at the end of the day is recommended if you see more than 20 patients a day. A monthly legal copy should be given to your attorney or accountant.

Know your computer system as well as you know dentistry to insure the success of your practice.

Belle M. DuCharme, RDA, CDPMA

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I am looking forward to having my finger on the pulse of my practice again. Thank you McKenzie Management.


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It’s nearly year end and I recall you had a letter to send out to those patients who had not used all of their insurance benefits. Can you please share it again?

Thanks! Love the newsletter!

Hi Carol,
No problem. Here it is.

Dear _______
Did you know that each year insurance companies make millions of dollars off patients who forego necessary and preventive dental care? Many individuals who are paying for dental insurance do not realize that their plans provide coverage up to a certain dollar amount annually. Consequently some patients are not scheduling the dental treatment they need, deserve and have insurance to cover. Thus, the insurance revenues allocated to pay dental claims on many patients are never used and unfortunately, those dollars cannot be carried over year to year. The bottom line…what the patient does not use they lose.

Clearly, it pays in many ways to schedule the preventive care or other dental treatment that you need. We are here to help you secure the insurance coverage available to you on every dental procedure you schedule. Our computer estimates that you are still have $xxxxx in unused dental benefits. Give us a call today and together let’s make sure you are in excellent dental health. As a special incentive for you to take charge of your dental care, we are offering a _____% reduction on dental treatment completed by January 1, 2005. Give (name of appointment scheduler) a call at 555-5555. I look forward to seeing you again and sharing some of the many innovative means we now have available to provide you with superior dental health care.

Dr. Best Dentist USA

P. S. Find out about additional interest free financing options for dental care. Check with _____in my office for all the details.


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