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How to Determine Returning Patients

How do you classify a patient who has returned to a practice after 3 years? I believe this patient should be scheduled for a comprehensive exam with X-rays with the dentist first before seeing me for a prophylaxis. However, one of my colleagues is questioning the ethics of this approach.

There are many reasons why individuals postpone dental care. Regardless, a plan should be established identifying how and with whom to schedule the returning appointment. Variations may occur concerning how much time should be allotted for this appointment and whether it should be scheduled with the dentist or dental hygienist. Several factors—such as office policies, insurance coverage, legal and ethical considerations, and patient circumstances—play a role in the decision-making process.

Dental offices may require the dentist to perform a comprehensive examination on new patients prior to the dental hygienist providing preventive services. This is advantageous since radiographs are typically taken and the dentist will formulate a treatment plan that identifies not only restorative procedures but determines if periodontal treatment is necessary. This scheduling process can also be applied to patients who are returning from an extended absence. First scheduling the appointment with the dentist avoids situations where a patient’s treatment needs are determined to be more extensive than the typical prophylaxis appointment allows.

When an established patient has been absent from the office for 3 or more years, a comprehensive exam can be billed using the Current Dental Terminology (CDT) code D0150. This code can be applied to “…new patients; established patients who have had a significant change in health conditions or other unusual circumstances, by report, or established patients who have been absent from active treatment for 3 or more years.”1 If this code is used, the exam should be more comprehensive than a periodic examination (CDT code D0120). As such, appropriate time in the dentist’s schedule should be allotted and a preventive appointment with the dental hygienist follows. However, if established patients who have been absent from the dental office less than 3 years return for a prophylaxis and examination, the appointment can be scheduled with the dental hygienist. In this case, a D0120 periodic exam code is typically billed when the dentist completes the examination. Dental hygienists may treat patients prior to the examination if they comply with the written protocols of the office.

When determining the time to be allotted for the appointment scheduled with the dental hygienist, patient circumstances should be considered such as age, health history, periodontal history, and history of calcareous deposit and debris formation. Treatment times should be individualized. For example, a 21-year-old patient returning from college may have different needs than a periodontal patient who was previously placed on a 3-month recare regimen.

Patients who have been absent from the practice for an extended period should be scheduled additional time compared to compliant patients. An additional 15 minutes to 30 minutes should be provided so that the medical history, radiographs, and assessments can be updated, and the dentist has enough time to be apprised of the patient’s status, complete the examination, and discuss treatment needs. The prophylaxis can be performed at this appointment, but a patient’s clinical condition may require him or her to return to complete preventive care. In this case, explaining why the patient needs to return is important and alternative CDT codes exist that allow for additional appointments.

References

  1. Medical Coding Guide. Dental Codes d0150, d0120 and d0180 Coding Guidelines. Available at: americanmedicalcoding.com/dental-code-d0150-d0120. Accessed November 29, 2022.
The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele P. Carr, RDH, MA, EdD, on ethics and risk management; Denise Muesch Helm, RDH, EdD, on fluoride; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpen ing; Kathleen O. Hodges, RDH, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Martha McComas, RDH, MS, on patient education; Michael W. Roberts, DDS, MScD, on pediatric dentistry; Purnima Kumar DDS, PhD, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to dimensionsofdentalhygiene.com/asktheexpert to submit your question.

From Dimensions of Dental Hygiene. January 2023; 21(1)46.

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