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The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 1 Code Definitions… Tricks of the Trade…

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Presentation on theme: "The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 1 Code Definitions… Tricks of the Trade…"— Presentation transcript:

1 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 1 Code Definitions… Tricks of the Trade…

2 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 2 D 4341 – Quad SRP D4341: general bleeding on probing 4-5 mm pockets plus presence of calculus along with radiographic evidence of bone loss. CDT 2009/2010 defines a quad as 4 teeth or more. D4910 follows SRP with typical 90-day exclusion.

3 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 3 D 4341 – Quad SRP Most insurance companies have a month exclusion for retreatment Include diagnostic films to document bone loss. Narrative check list is often not appropriate.

4 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 4 D4342 – SS SRP D4910 always follows D4341/D4342. For a few isolated teeth – D1110 may be appropriate. Always put the tooth # on the insurance form. D4342 is active therapy – not prophylactic (D1110) or supportive (D4910).

5 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 5 D4342 – SS SRP along with D1110 If both 4324 & 1110 are necessary: Consider D st appt., D nd When D4342 is performed first - may trigger 90 exclusion of prophy

6 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 6 The Big Reveal by MetLife, CIGNA, Delta Dental As reported in: Insurance Solutions Newsletter September/October 2008 issue

7 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 7 D4341 / D4342 – MetLife requires >4mm pockets + attachment loss Pseudopockets without bone loss should be coded D1110 The Big Reveal by MetLife, CIGNA, Delta Dental

8 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 8 MetLife now pays SRP once every 24 months. MetLife reviewed 1,750,000 claims for D4341 / D4342 in All 3 now allow payment for D1110 and D4342 on the same day. The Big Reveal by MetLife, CIGNA, Delta Dental

9 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 9 D4910 – MetLife pays 4x year for most policies. SRP should only be reported again if there is evidence of progression of disease (further attachment loss, bleeding, recession, discharge, etc.). The Big Reveal by MetLife, CIGNA, Delta Dental

10 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 10 MetLife no longer denies D4910 if billed within 90 days of D4341/D4342. MetLife requires 2 quads of D4341 before covering D4910 (unless narrative states only one quad was infected). The Big Reveal by MetLife, CIGNA, Delta Dental

11 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 11 CIGNA DHMO only covers D4910 2x year for the first 12 months following active therapy. Delta varies depending on Delta plan. The Big Reveal by MetLife, CIGNA, Delta Dental

12 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 12 The Big Reveal by MetLife, CIGNA, Delta Dental – D4381 CIGNA does not define a minimum pocket depth for D4381. When a CIGNA plan covers D4381 there if benefit for up to 8 teeth at the time of SRP. If 9 teeth are treated, CIGNA denies all. Delta requires 5 mm pockets that bleed.

13 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 13 Delta covers up to two teeth per quad but not until the 6 week re-evaluation after SRP. MetLife will cover D4381 w/ 6 mm pockets at the time of SRP. The Big Reveal by MetLife, CIGNA, Delta Dental – D4381

14 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 14 MetLife will only pay D4381 on the same tooth once in 12 months. MetLife believes systemic antibiotics are more appropriate when more than 12 teeth are infected. The Big Reveal by MetLife, CIGNA, Delta Dental – D4381

15 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 15 Narrative Check List (for internal use – not insurance) Active disease with alveolar bone loss Active disease with alveolar bone loss _____ or greater loss of perio attachment _____ or greater loss of perio attachment Radiographic evidence Radiographic evidence Bleeding on probing Bleeding on probing Gingival recession Gingival recession Furcation involvement Furcation involvement Inflammation Inflammation Increasing tooth mobility Increasing tooth mobility Subgingival calculus Subgingival calculus Suppuration Suppuration

16 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 16 Narrative for All Four Quads on the Same Day Purpose: to disinfect the entire mouth _____ minutes spent on appointment _____ anesthesia used _____ pre-medication used Apprehensive patient Medical condition:____________________ Travel time _________________________

17 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 17 D4355 Gross Debridement Only used when comprehensive exam D0150 or comprehensive periodontal exam cannot be performed due to excessive and bulky calculus, heavy plaque and debris buildup. Comprehensive evaluation generally follows debridement typically 14 days later. D4355 generally reimbursed 25-33% of the time.

18 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 18 D4355 Gross Debridement D4355 is not a definitive treatment. A prophy, referral to periodontist, or scaling and root planing always follows this preliminary procedure. D4355 should not be reported as a first prophy.

19 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 19 D4381 Localized Delivery of Antimicrobial Agents Placement of FDA-approved localized antimicrobial agents such as Arestin ®, PerioChip ® and Atridox ®. It is adjunct to D4342 or D4910. The code may not be reimbursed at the initial SRP appointment. Trend is to pay at first appointment.

20 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 20 D4910 Periodontal Maintenance This procedure follows perio therapy and continues at varying intervals, determined by the clinician. D4910 does not include the evaluation – always charge separately. This procedure is on-going and therapeutic, not preventive.

21 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 21 D4910 Periodontal Maintenance Typically has a 90-day exclusion following active therapy. It is improper to alternate between 1110 and The patient cannot be a perio patient one visit and prophy visit the next.

22 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 22 D9910 Application of Desensitizing Medicaments May be used as an adjunct to SRP or for treating sensitivity Not typically reimbursed Consider D9110 – palliative treatment – for sensitivity at an emergency visit.

23 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 23 Subgingival Irrigation Local Drug Delivery Atridox ® – doxycycline gel that conforms to the gum surface and then solidifies over the next few days.

24 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 24 Local Drug Delivery Subgingival Irrigation Local Drug Delivery Elyzol ® – is a gel or strip applied to the gum that is composed of metronidazole. Effective against parasites as well as bacteria. Studies show Elyzol achieves a greater bacterial reduction where doxycycline works faster.

25 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 25 Subgingival Irrigation Local Drug Delivery PerioChip ® – Placed into the gum pocket after scaling, the chip slowly releases chlorhexidine – a powerful bacteria-killing antiseptic. Reduction of pocket depths is reported – but it is not known whether these improvements are sustained.

26 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 26 Subgingival Irrigation Local Drug Delivery Minocycline microspheres (Arestin ® ) contain antibiotics in tiny capsules. Studies report they are more effective in reducing pocket depth and bone loss than standard perio maintenance. Patients obtain these benefits regardless of their smoking status, age, gender, or extent of disease.

27 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 27 Local Drug Delivery Perio Protect – home care treatment program for perio disease. Perio Protect – home care treatment program for perio disease. Medial device is a set of custom fabricated Perio Protect Trays. Medial device is a set of custom fabricated Perio Protect Trays. The trays guide antimicrobial agents into the infected area (gingival sulcus) and maintain the medication for a specific time. The trays guide antimicrobial agents into the infected area (gingival sulcus) and maintain the medication for a specific time. Must be a licensed Perio Protect partner. Must be a licensed Perio Protect partner.

28 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 28 Systemic Antibiotic Therapy Periostat ® - subantimicrobial dose doxycycline (SDD). Very low dose (20mg) doxycycline is too low to affect bacteria. The drug blocks matrix metalloproteinase – enzymes that destroy the connective tissues holding the teeth.

29 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 29 Taken 2x day for months. Several 12-month studies report significant improvements in tooth attachment and pocket depth with no increased incidence of side effects. Systemic Antibiotic Therapy

30 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 30 Irrigation Recommendations Povidone-iodine: 10% concentration applied repeatedly by an endodontic syringe to obtain a contact time of at least 5 minutes. Generally performed after SRP. May also be done prior to mechanical debridement to reduce risk of bacteremia.

31 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 31 Povidone-iodine: Ultrasonic scaler usage - 10% solution is diluted by mixing 1 part solution with 9 parts or less of water. Povidone-iodine mouth rinse/gargle has shown a reduction in gingival surface bacteria by about 33%. Irrigation Recommendations

32 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 32 Povidone-iodine: American Heart Association suggests that antiseptic mouth rinse applied immediately prior to dental procedures reduces the incidence or magnitude of bacteremia. Irrigation Recommendations

33 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 33 Sodium hypochlorite (household bleach) Benefits: Broad antimicrobial activity Rapid bactericidal action Relative non-toxicity No color, no staining Ease of access, very low cost Irrigation Recommendations

34 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 34 Sodium hypochlorite (household bleach) Household bleach usually contains % chlorine. 1 part bleach combined with 49 parts water makes appropriate working solution of 0.1% or 1000 p.p.m. Working solution: 1 tsp. bleach to 16 oz. water delivered subgingivally via oral irrigator at a high pressure setting. Irrigation Recommendations

35 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 35 Irrigation Recommendations Chlorhexidine Chlorhexidine mouth rinse to combat biofilms in supragingival and oral mucosal sites are performed with ml of % solution for 30 seconds 2x / day. Chlorhexidine has a propensity to dark-stain teeth and tooth-colored restorations.

36 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 36 Chlorhexidine.2% Chlorhexidine is usually not effective for subgingival irrigation. It causes less change in subgingival microbes than low strength povidone- iodine. Irrigation Recommendations

37 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 37 Chlorhexidine Chlorhexidine chips for subgingival placement are capable of reducing mean probing depths by less than 1mm in 4-6 mm deep pockets. It may not cause noticeable reduction in periodontal pathogens compared to thorough SRP. Irrigation Recommendations

38 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 38 Case Typing Case Type PD (mm) BOP (Y / N) Bone Loss% Mobiliy (Grade) Furcati ons (Grade) CAL (mm) Visual Inflammation 0 - Health0-3No0None 0No I - Gingivitis0-4Yes0NoneNove0 Yes (local or generalized)* II – Slight Chronic Periodontitis ¹ 4-5Yes10I11-2 Yes (local or generalized)* III – Moderate Chronic Periodontitis ¹ 5-6Yes33I & II1 & 23-4 Yes (local or generalized)* IV – Severe Chronic Periodontitis ¹ 6Yes 33 I, II or III 1, 2, 3 or 4 5 Yes (local or generalized)* V – Aggressive Periodontitis age is significant factor ² 6Yes 33 I, II or III 1, 2, 3 or 4 5 Yes (local or generalized)* * Localized disease is defined as 30% of sites, Generalized 30% of sites ¹ Specific referral may be indicated for additional treatment beyond initial treatment ² Specialty referral should be considered Clinical Attachment Loss

39 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 39 Guidelines for the Management of Patients with Periodontal Diseases (AAP 2007) LEVEL 3: patients who should be treated by a periodontist. LEVEL 2: patients who would likely benefit from co-management by the referring dentist and periodontist. LEVEL 1: patients who may benefit from co-management by the referring dentist and periodontist.

40 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 40 Soft Tissue Classifications (According to AAP) Health - Prophy Coral pink gingiva. Pointed papilla. No bleeding upon probing. Probing 0-3mm.

41 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 41 Case Type I – Diagnostic Code: Gingivitis Plaque induced / non-plaque origin Localized or generalized ( 30% sites) Edematous gingiva. Bulbous papilla. Probing 0-4mm. Immediate bleeding upon probing may delay up to maximum of 30 seconds after probing. Soft Tissue Classifications (According to AAP)

42 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 42 Case Type II – DX Code: Slight Periodontitis Localized or Generalized ( 30% sites) Edematous and smooth gingiva. Probing 3-4 mm. Delayed bleeding upon probing. Light to moderate calculus sub-and supragingival. Soft Tissue Classifications (According to AAP)

43 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 43 Case Type III – DX Code: Chronic Periodontitis Localized or Generalized ( 30% sites) Horizontal and vertical bone loss Tissue red, texture smooth Probing 4-6 mm Slight mobility Furcation involvement Bleeds easily Heavy sub-gingival calculus Soft Tissue Classifications (According to AAP)

44 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page Case Type IV – DX Code: Aggressive Periodontitis Localized or Generalized ( 30% sites) Horizontal and vertical bone loss Probing 6+ mm Generalized tooth mobility Soft Tissue Classifications (According to AAP)

45 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 45 Case Typing… Decisions / Changes

46 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 46 Prophy Mirror Explorer Probe Scaler Gracey 1-2 Challenge: All other instruments packaged separately

47 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 47 Diagnostic Assessment Assess- ment Health Gingivitis Slight Perio- dontitis Moderate Perio- dontitis Advanced Perio- dontitis Aggressive / Refractory Prophy Fl 2 OHI Prophy Fl 2 OHI D0417* D0150 D0120 D0180 D0274 D0277 D0210 D0330 D0417* D0150 D0120 D0180 D0274 D0277 D0210 D0330 D4355 D9950 (occ anal) D0417* D0150 D0120 D0180 D0274 D0277 D0210 D0330 D4355 D9950 (occ anal) Referral D0417* D0150 D0120 D0180 D0274 D0277 D0210 D0330 D4355 D9950 (occ anal) Referral D0417 Collection and preparation of saliva sample for laboratory diagnostic testing

48 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 48 DX Code: Gingivitis Plaque induced / Non-plaque origin Localized or generalized ( 30% sites) D0120Periodic oral exam D0150Comprehensive oral examination D0160Problem focused exam D0180Periodontal exam Gingivitis Coding Appointment 1 Narrative + perio charting for increased fee

49 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 49 Gingivitis Coding Appointment 1 D4355Full mouth debridement D1330Oral hygiene instructions D0210Intraoral complete series (including bitewings), or D0330Panoramic film, with D0274Bitewings – 4 vertical films, or D0277Vertical bitewings (7-8 films) New Code # BWX Caution: paid without exam or x-ray -- try 9110 palliative

50 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 50 D0170Re-evaluation – limited, problem-focused D1110Coronal Polish D1204Adult fluoride, or D1206Varnish fluoride D1330Oral hygiene instructions Gingivitis Coding Appointment 2

51 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 51 D0120Periodic oral exam D0150Comprehensive oral examination D0160Detailed and extensive oral evaluation – problem focused, by report D0180Periodontal exam D0210Intraoral complete series (including bitewings) Periodontal Coding Appointment 1

52 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 52 This appointment includes comprehensive perio screening for pocket depths, bleeding, and severity, furcation involvement, recession from the CEJ, plaque score, mobility, and bone loss. Periodontal Coding Appointment 1

53 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 53 D0417 D0417Collection and preparation of saliva sample for laboratory diagnostic testing D4355Full mouth debridement D1330Oral hygiene instructions D4935Consultation for diagnosis and treatment plan Periodontal Coding Appointment 1

54 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 54 D4341Periodontal scaling / root planing by quadrant OR… Periodontal Coding Appointment 2 & 3 Current theory - Do as many quadrants as possible in one appointment to not cross-contaminate completed quads. Never more that 30 days between therapies.

55 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 55 D4342Periodontal SRP 1-3 teeth, #_____, #_____, #_____ D4381Arestin ®, PerioChip ®, etc. D1330Oral Hygiene Instructions Periodontal Coding Appointment 2 & 3

56 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 56 D4380Re-evaluation of periodontal therapy (examine tissue response, re-measure pockets) D1110Coronal polish D1204Adult fluoride D1206 Fl 2 varnish D1330Oral hygiene instructions Periodontal Coding Appointment 4

57 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 57 Decisions / Changes Treatment Sequencing…

58 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 58 Ongoing Maintenance Case IndicatorHealthGingivitis Slight Perio- dontitis Moderate Perio- dontitis Advanced Perio- dontitis Aggressive / Refractory 6 Months Prophy OHI 6 Months Prophy OHI 3 / 4 / 6 months D4910 OHI D4381 UL, UR, LL, LR D4342 Other 3 / 4 / 6 months D4910 OHI D4381 UL, UR, LL, LR D4342 Other 3 / 4 / 6 months D4910 OHI D4381 UL, UR, LL, LR D4342 Other 3 / 4 / 6 months D4910 OHI D4381 UL, UR, LL, LR D4342 Other 3 / 4 / 6 months D4910 OHI D4381 UL, UR, LL, LR D4342 Referral to Specialist

59 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 59 Periodontal Recare Sequence Appointment 5: 1 st recare or 4-6 week evaluation D0170Re-evaluation D0180Periodontal exam D4910Periodontal maintenance D1330Oral hygiene instructions D1204Adult fluoride D1206Varnish Fee Waived

60 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 60 Fluoride Advantages CARD C =Caries reduction A = Antimicrobial R = Remineralization D =Desensitizing

61 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 61 ADA Fluoride Assessment 28% caries reduction with 1 min swish 28% caries reduction with 1 min swish 37% caries reduction with 4 min foam or gel 37% caries reduction with 4 min foam or gel 74% caries reduction with varnish 74% caries reduction with varnish

62 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 62

63 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 63 Varnish D1204 – topical application of fluoride – adult D1206 – topical fluoride varnish: therapeutic application for moderate to high caries risk patients. NOT to be used for desensitization. D9910 – application of desensitizing medicament.

64 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 64 Site Specific Perio Treatment You must make todays appointment look different than the last appointments prophy. Use the charts documentation as your starting point: Mrs. Smith, I see by your chart that the last time you were here the hygienist determined there was a gum problem on the upper right between your molars.

65 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 65 Site Specific Perio Treatment The first thing I want to do is check that area. If you have not had the healing I would expect at this point, I will do a non-surgical procedure to clean the area for you and place an antibiotic in the pocket to promote healing. You cannot continue with the active gum infection. Let me go ahead and get that numb for you while we continue with your healthy mouth cleaning.

66 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 66 Site Specific Perio Treatment This is a disease-related procedure and insurance may cover it differently than the healthy cleanings you are used to. Would you like me to have Sue, our financial coordinator, step back and explain how your insurance will aid you with this procedure?

67 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 67 Anesthesia ® Oraqix ® – (2.5% lido, 2.5% prilo.) Emla – (2.5% lido, 2.5% prilo.) Profound (10% Lido, 10% Prilo, 4% Tetracaine) / Profound Lite Stevens Pharmacy Costa Mesa, CA (800) 352-DRUG

68 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 68 Decisions / Changes Periodontal treatment sequencing… Fluoride… Anesthesia…

69 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 69 Exam Definitions D0120 – Periodic oral evaluation – established patient D0150 – Comprehensive oral evaluation – new or established patient (absent from active treatment for 3 or more years)

70 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 70 Exam Definitions D0180 – Comprehensive periodontal evaluation – new or established patient. Patient shows signs or symptoms of periodontal disease and for patients with risk factors such as smoking or diabetes. Includes: evaluation of perio conditions, probing and charting, evaluation and recording of patients dental and medical history and general health assessment. Record: dental caries, missing or un- erupted teeth, restorations, occlusal relationships and oral cancer evaluation.

71 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 71 There are 3 types of patient exams: 1- to 3-minute exam - Patient is in excellent health - No or minimal case presentation is needed. 3- to 5-minute exam-New or re-presented treatment is discussed by doctor. Increasing Exam Efficiency

72 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page minute exam Complete treatment plan presented. Time necessary is noted in huddle. Doctor does cursory exam at no charge. Patient is re-appointed for status exam. Fee is charged at status exam. Increasing Exam Efficiency

73 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 73 The Exam Data collection Treatment planning Scale / polish minutes of appt. Call doctor for exam Run behind!!!

74 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 74 The Finish – The Exam Data Collection Treatment planning Call doctor – min Scale / polish Call doctor again min Call doctor again Run behind!!!

75 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 75 The Finish – The Exam Data Collection minutes into appt Green Time Doctor examines at his convenience Call Doctor again No time to discuss TX plans w/pt Yellow Time Red Time Do the hygiene dance behind doctor Role eyes at dental assistant Apologize to next patient for being late

76 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 76 The Finish – Doctor enters for the exam

77 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 77 Acknowledge – Affirm the Patient What have you been talking about? What would you like me to look at? Blood Pressure Medical History / Medications Perio Status Life Status – Blue Sheet Next Hygiene Visit Patient Concerns Previously Diagnosed Treatment New Findings The Finish – The Exam

78 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 78 Baton Pass to the Business Team Cheryl, Dr. Smith would like Linda to schedule an appointment to complete treatment on the lower right - either at the end of the week or beginning of next week.

79 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 79 Decisions / Changes Treatment Planning… The Exam…

80 The Hygiene Academy November 2008 Paragon Management Associates, Inc. Page 80 Before you go for a great evening… Prioritize the Top 5 ideas you would like to discuss or implement in your office. Prioritize the Top 5 ideas you would like to discuss or implement in your office. Enjoy yourself this evening – Dont eat or drink too much! Enjoy yourself this evening – Dont eat or drink too much! See you at 8:00 am tomorrow See you at 8:00 am tomorrow


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