Final Flashcards
(99 cards)
1
Q
What is a K code?
A
Dx code for a disease
2
Q
What is SNOWDEN?
A
Dental diagnostic method
3
Q
What is a treatment code called?
A
D code (the ones we see)
4
Q
SNOWDENT is harmonized with???
- ICD 11
- ICD 10
- ICD 1
- ICDAS
A
ICD 10
5
Q
First university to use Z codes? What is the Z code?
dx code, tx code, dental classification dz, dental diagnostic method
- University of Boston
- University of NY
- University of Toronto
- University of California
A
University of Toronto
Z code = dental classification of disease
6
Q
What percentage of schools use code driven treatment?
- 10-20%
- 20-30%
- 30-40%
- 40-50%
A
42% USE IT
6% are ready to use it
24% are going to use it
28% DO NOT USE
7
Q
Why should we move towards diagnosis driven codes?
A
To justify the treatment plan
8
Q
What is a benefit code?
A
A code that the insurance will cover (D1354)
9
Q
What is a billable code?
A
A treatment code (ex: OHI)
10
Q
How many categories of services exist?
A
13
11
Q
D0 code is
A
Diagnostic
12
Q
Give the CDT code categories in order:
A
Diagnostic
Preventive
Restorative
Endo
Perio
Prosth, removable
Maxillofacial pros
Implant
Prosth, fixed
Maxillofacial surgery
Ortho
Sleep Apnea
Adjunctive general services
13
Q
D5 code is
A
Prosth removable,
Maxillofacial prosth
14
Q
D9 code is
A
Adjunct general svcs,
Sleep apnea
15
Q
D6 code is for:
A
Implant
Prosth, fixed
16
Q
Which D codes cover more than one treatment
A
D5, D6, D9
17
Q
The D Code for Endo is:
D0
D1
D2
D3
D4
D5
A
D3
18
Q
The D Code for Perio is:
D0
D1
D2
D3
D4
D5
A
D4
19
Q
The D Code for Resto is:
D0
D1
D2
D3
D4
D5
A
D2
20
Q
The D Code for Oral maxillofacial surgery is:
D0
D1
D2
D3
D4
D5
A
D7
21
Q
Which of the following does not need to be filled out for insurance purposes:
Procedure date
Location
Tooth system
Tooth number
Tooth surface
Procedure code
Quantity
Description
Fee
Diagnosis Code
Remark
Missing teeth
A
Remarks,
Quantity (sometimes)
22
Q
When signing a billing form, what dentist specific information should be filled out?
A
Signature
Date
NPI
License Number
TIN
23
Q
Common errors related to insurance (most common are) which of the following? (do them in order):
Details, Documentation, Fee, Frequency, Process, Procedure
A
Frequency
Procedural
Documentation
24
Q
Identify the error in this insurance code? D1110
A
D1110
6 month + 1
25
Identify the error in this insurance code? **Onlay**
MOD inlay and MOD onlay codes
26
Identify the error in this insurance code? Direct restoration MO and DO same day
MOD bill otherwise insurance will only pay for 1
27
Which statement is true? Which is false?
A billable code is always a benefit code.
A benefit code is always a billable code.
**False**: A billable code is always a benefit code.
**True**: A benefit code is always a billable code.
28
Takes the place of a regular dentist who may be on vacation or temporary leave (so that the office can function normally):
Locum tenens
29
Automatic pass is
## Footnote
infection control
0
30
Score that goes on your record, not transcript
6-9 points
31
What happens if you have any of the following infractions? What is your score?
Didn't raise chair
Foot pedal is not placed on the base
Trash bag not tied
No hand washing
Not wearing gloves with patient
Not using proper aspiration
Not disposing of single use instruments
Not cleaning or package insturments
Verbal warning,
2-5 points
32
3 examples of 6-9 point infractions
Not recapping needles
Having food/drink
Missing mandatory trainings
33
The dx code drives _ code
**treatment**
34
Pathway to SNOWDENT?
ICD 10 drives *SNOWMED* --> SNOWMED affects --> **SNOWDENT** --> SNOWDENT affects --> SNOWDDS
ICD 10 to SNOWMED to SNOWDENT to SNOWDDS
35
How many points will result in an NP?
10+
36
Violations that result in a NP:
Not wearing N95
Missing N95 certification
Sharps in the trash
Not returning instruments within 24 hours.
37
Automatic NP (2)
Missing N95 certification
Sharps in the trash
38
Most common infractions (4)
1) Not purging water lines (2 min morning, 30 sec afternoon)
2) Not wearing proper eye protection
3) Patients don't have on eye protection (wrap around)
4) Not applying protective barriers in clinic
39
If you get a red paper, this means you have
a sharps violation
40
3 most common accidental exposure chart reasons
1st Scalpel injury
2nd Burs/Piezo
3rd Needles
41
When do you use the hazardous waste bins?
When items are soaked in blood, use the red bin only
42
Other waste/clinic violations
1. Sharps container full and you use trash
2. Dirty sinks
3. Tray adhesive sprayed outside of the box
4. Liquid waste it the red container
5. Teeth with amalgam not in correct container
6. Cover the chairs and tables with big bags
7. Take off gloves when you leave the cubicle
8. Cannot wear gowns in elevators
9. Must disinfect impressions before moving them
43
T/F: Teeth with amalgam go to biohazard
False -- go to amalgam container
44
dental and medical practice billing differences:
Medical billing has been ____ and ____ have been captured using _____ terminology.
Medical billing has been standardized and causes of death have been captured using standard terminology as well. In modern dentistry, we still **do not** capture **why a tooth is non-vital or why one is extracted**
45
How are ICD and SNOWMED different?
ICD is "sparse" and SNOWMED is enormous/lots of information
46
SNOWDDS = ___ + _____
A combination of SNOWMED and SNOWDENT
47
Dates of founding and place in order:
SNOMEDCT
SNOWDENT
ICD-10
SNOWDDS
1965: ICD-10
1990S: SNOWDENT
1999: SNOWMEDCT
2017: SNOWDDS
48
Issues with the earlier dental classification system?
insufficiently subdivided, scattered code arrangement (poor organization)
49
comprehensive, multilingual clinical healthcare terminology for use in the EHR describes ____
SNOMEDCT
50
When were standardized diagnostic terminologies first used?
250 years ago
51
What is EHR?
Electronic Health Record
52
International Classification of Diseases (ICD) was founded in
1893
53
Who cannot use SNOWDENT
The general practitioner, dental schools (must be licensed)
54
Who created SNODENT? Who had led it since the early 1990s?
WHO: Created
ADA: Manages
55
First dental classification of disease is
Z Code
56
What is the Z Code?
First dental classification of disease -- 1999 (UT)
57
Why is SNODDS-GD not used by the ADA?
They want a more simple version to communicate medical codes
58
Explain the study from article 2:
25 students from Harvard (12) and UCSF (13) who were D3 or D4 students with at least 6 months in the clinic, Axium usage and 2 years of training were monitored for their ability to properly diagnose, treatment plan based on the diagnosis and develop a logical treatment sequence
59
In study 2, if the wrong diagnosis was selected, how often was the **correct treatment** selected?
81% of the time
60
What are some of the concerns/weaknesses about this study?
@ Observer may have influenced the results
@ "think out loud" process was not used
@ limited number of participants
@ moderators themselves did not always strongly agree
@ participants were selected based on "convenience"
@ familiarity with the technology
61
How many students scored poorly with the tx organization/sequence?
41%
62
What were the two ways to enter the treatment?
Chart Add,
Tx Planning Module
63
How should a treatment plan be organized (in 5 steps):
1. Deal with the chief complaint (pain and infection first)
2. Disease control
3. Tooth replacement and reconstruction
4. Esthetic/cosmetic concerns
5. Preventive and maintenance
64
Why may tx planning vary among dental students nationwide?
There is no teaching or development standard
65
Steps in the study for tx planning (4)
1. Chief complaint
2. Dx from a comprehensive list
3. Tx objectives
4. Detailed tx plan
66
Per the study was it easier for the students to choose the correct tx or the correct dx?
Choosing the correct **treatment**
67
What to submit for a fee reduction:
Consultation form from original faculty, Chart info (should be updated)
Additional info (private meeting)
68
What should be included for in the consultation for a fee reduction review?
#1 - Root cause of failure
#2 - Proposed improvement
69
Who can do the consultation for the fee reduction?
#1 - original faculty
#2 - section chair
*#3 - Resto faculty + GPD/GPL
70
What should be updated before submitting the fee reduction request? (6)
X Rays
Medical and Dental Hx
Medications
POE (eval)
Perio Signature
CRA/CAMBRA
71
Maximum time for re-dos for the following:
#1 Crown/bridges
#2 Intracoronal filling
#3 - Perio
#4 - Prosth
Crowns - 5 years
Fillings - 2 to 3 years
Perio - **1 week**
Prosth - 12 months
72
Can we do a fee reduction on an unsatisfied treatment case?
Sometimes, as a good will measure
73
Put these in order for a fee reduction generation process:
Faculty approval
Provider gets info
**right click** to Add/edit tx form
Select mother code (with fee attached)
Run to Dr. Mong
Select fee reduction and fill out the form
Faculty initiated process
1 - Faculty initiated process
2 - Provider gets info
3 - Select mother code
4 - Right click to add/edit tx form
5 - Select fee reduction to fill out form
6 - Faculty approval
7 - Run it to Dr. Mong
74
How long does it take to process a fee reduction request?
10 working days
If more information is NOT requested
75
Fee reductions are only considered for ___ cases
completed
76
If additional information is needed for a re-do, what will you discuss?
- history of issue
- faculty and provider involved in the case
- Clinic and resident involved in the case
- your assessment and proposed solution
77
Fee reduction workflow (re-order):
Billing, Approval, Completion. Submission, Start Work
Submission, Approval, Start Work, Completion, Billing
78
Dos and do nots of fee reduction:
DO: tell patient we will look into the request
DON'T: Promise the redo will be covered
DON'T: start the re-do without approval from the clinic director
79
For most dental practices, an C Corp/S Corp is generally more advantageous due to its tax benefits and simpler
tax reporting. However, a C Corp/S Corp might be preferable for practices planning significant growth or seeking
substantial investment due to its flexibility in ownership and stock options.
S Corp,
C Corp
80
Cons of a C Corp:
Cons:
1. Double Taxation:
(corporation pays
taxes on its income, and shareholders also pay taxes on dividends received.)
2. Tax Complexity: It's a corporation
3. Operational Complexity: more compliance methods required
81
Unlimited shareholders
Formation simplicity
Stock flexibility
**PROS** of a C Corp
82
Formation compliance
Ownership restrictions
CONS of S Corp
Complex Formation: Forming an S Corp requires filing Form 2553 with the IRS and possibly
additional state-specific forms, making it more complex than forming a C Corp.
- Increased Scrutiny: The IRS tends to scrutinize S Corp tax filings more closely, and inaccuracies can
lead to the revocation of S Corp status.
2. Ownership Restrictions:
- Shareholder Limitations: S Corps can have no more than 100 shareholders, all of whom must be U.S.
citizens or residents. This can be restrictive compared to C Corps.
- Single Class of Stock: S Corps can only issue one type of stock, limiting flexibility in structuring
ownership and investment.
83
Max # of shareholders for S Corp? C Corp?
100 - S Corp
unlimited - C Corp
84
* Tax benefit (avoid double taxation, tax deductions)
* Ownership structure (limited shareholders)
*Simplified Tax Reporting (pass through taxation)
**PROS of S Corp**
1. Tax Benefits:
- Avoids Double Taxation: S Corps are pass-through entities, meaning business income is reported on
the owners' personal tax returns, avoiding the double taxation seen with C Corps.
- Tax Deductions: Owners can deduct up to 20% of their business income on their personal tax
returns, potentially saving a significant amount of money.
2. Ownership Structure:
- Limited Shareholders: S Corps can have up to 100 shareholders, which is usually sufficient for dental
practices that typically have a small number of owners.
3. Simplified Tax Reporting:
- Pass-Through Taxation: All items of income, loss, and credit from the business are reported directly
on the owner's individual federal income tax return, simplifying the tax process.
85
What the the UCLA subsidies?
Apollonian
Endo
Friends and Family
Dentical
86
Max Apollonian society benefit **per student**?
Max **per patient**?
What are the other rules?
$1500 per student
$1000 per patient over a 2 year period
D3/D4 student only
Must be tx in the general clinic
NOT in grad clinic
NOT to be used as a co-pay
NOT stackable
NOT transferrable
87
When must billing approve the Apollonian subsidy?
Before the treatment starts
88
Apollonian subsidy must be linked ____.
It is for ____ issues.
Not to be used for ___ (tx - 3)
**no cash value or refund**
How can you get 100% coverage?
linked to provider
genuine payment issues
prophy/X Ray/ lab rush fees
By being a D4
89
Apollonian percent for 100%? 70%? 50%?
100% - D4s
70% - Endo RCT, Perio Sx, CD/RPD/implant, Resto - indirect, FPD
50% Perio SC/RP (non-surgical), resto
90
Rules for the Endo subsidy:
- Endo tx approved by Endo faculty
- Tooth restorable, Resto approved
- 50% courtesy on Endo TX
** pre doc** and **must submit ALL crown fees before RCT is started**
- Max 2 RCT per provider, not on the same patient
- Ineligible - if tx already started without the complete crown payment, referred to resident
91
Friends and Family percent off?
20%
92
What makes an Endo subsidy ineligible?
Referred to resident
Already started the RCT tx without a **complete** crown payment
93
When does the Family and Friends discount not work?
Perio surgery
Oral surgery
RCT
implant
implant crown
94
Eligibility for the Denti-Cal subsidy...
60 or older
Denti-Cal eligible **during** tx
$400 max per patient
covers what Denti-Cal will not
95
Max amount for the Denti-Cal subsidy
$400
96
Which is true of the Apollonian subsidy?
1. Can be in general or grad clinic
2. Can be used as a co-pay
3. Not transferrable
4. Not stackable
Must be tx in the general clinic
NOT in grad clinic
NOT to be used as a co-pay
NOT stackable
NOT transferrable
97
Denti-Cal preauthorization is needed for which procedures?
o Cd , rpd
o Crown
o Endo
o Exams
o Extractions
o Immediate denture
o Prophylaxis/ fluoride
o Sc/ root planing
o Am, composite
o PM/ prophy
CD/RPD
Crown
Endo
SRP
98
When are anterior and posterior crowns covered with Denti-Cal?
Anterior crown **More than 50% tooth gone structurally**
Posterior crown (or requirement): **RPD, Survery crown holding RPD, opposing full COMPLETE DENTURE**
Also
**, Premolar : missing 1 cusp/ 3 surfaces
Molar : missing 2 cusp/ 4 surfaces** 1/3, 2/4
o Part of an RPD design
* Survey crown holding RPD (must accompany RPD)
* Opposing FULL denture ** Cannot oppose RPD
99
How many years before a Denti-Cal crown may be covered again?
over 3 years
