dxr quick reference guide - augusta

DXR Quick Reference Guide

Ex Re Cc Tx

Exams Treatment Plans & Checklists

Case Completes

Referrals and

Consults

Please ‘Click’ one!


Ex

Exams

1. Exam Types

2. New Patients

3. DXR Checklist

4. Transfer Patients (D0006)

5. Audits for Transfer Patients

6. Checklist for D0006

Ex

4 Basic Exam Types

•D0120 - Periodic Exam - for patients who require a routine exam and

have been examined in the last 12-24 months

•D0150 - Comprehensive Exam - for patients whose condition has

changed significantly and require a comprehensive exam or have not been

examined in the last 24 months, also for new patients.

•D0006 - Administrative Re-examination code - Use this code when a

patient of record requires a re-examination (usually due to a transfer from

another student or an outside referral). This is a No-Charge exam and is

to be performed on ALL transfer cases and Outside referrals. If the patient

has not had an approved exam in the last 12 months they must go through

DXR first

•D0003,D0005 - Case Complete Exams -see section on Case Completes

Ex

Patient's First Appointments

New Patients

•For a New Patient requiring Comprehensive care (exluding Complete

dentures) they will get a Work-up appointment with OME to begin your

COE (Comp Oral Eval D0150) then they will have their treatment plans

evaluated at the DXR appointment.

•For a New Patient requiring Complete dentures - go directly to a

Removable Prosthodontic chair

Ex

D0006 - Re-Examination Code

•ALL TRANSFER PATIENTS REQUIRE A D0006

BEFORE RESTORATIVE WORK IS STARTED

Ex Student D0006 Audit

**In order to schedule your transfer patient for a work-up or a restorative (direct or

indirect) procedure you must complete the following audit on your record.

•Current Accurate Models

•Up to date Radiographs with Interpretation - following ADA 2004

guidelines

•Full mouth Probing Depths

•Approved and Signed Phased Treatment Plan - Chart additions vs Tx

Plan (Chart adds are not acceptable TX Plans)

•Examination (D0003, D0005, D0120, D0150 or Prophy) in last 12 mos

• If 2 or more are not satisfactory then you will need to schedule your

first appointment for a work-up in a Operative or Fixed chair.

Ex

Patient's First Appointments

Transfer Patients

•Make sure Audit is done before you schedule your patient!

•Transfer patients (typically from a senior to a junior) will usually go into a

Restorative chair to begin the D0006 (Re-examination code). If the patient

passes the audit then the faculty may complete the D0006, and if time

permits, the student may attempt a restorative procedure (Operative or

Fixed)

•If the patient's record fails the audit, the student will need to complete the

Work-up in the Restorative chair and then schedule an appointment in

DXR. The D0006 code will be left In-Process until the the DXR

appointment, when the faculty at that time will complete the code.

Ex

D0006 - Re-Examination Code

•Expectations for a D0006: Students are to Audit their own patient records

before appointments.

•This is a no-charge re-examination of the patient. Consider the D0006

much like a new patient DXR. Often these records are the most

challenging to sort through.

•Please do not expect to do any other treatment for your patient until the

D0006 is completed. Once the D0006 is completed you may begin

restorative care.

•This expectation is designed both protect the patient and provide an

opportunity to familiarize yourself with the record prior to treatment.

Ex

D0006 - Re-Examination Record Checklist

✓Updated films and Radiographic Interpretation

✓'In-Progress' tab has procedures that accurately reflect the Treatment Plan

✓Odontogram confirmed

✓ Probing depths confirmed and Perio consult as needed

✓Confirm Exam tab folders

✓CRA and Exam within last 12 months

✓Review prior TX Plans - make sure treatment has been followed as

sequenced

Ex

Student DXR Checklist

✓Updated films/Radiographic Interpretation - Completed

✓Odontogram Confirmed & Corrected

✓ Probing Depths Confirmed and Perio consult PRN

✓Confirm Exam Tab Folders with Summaries (Pre-med Req?)

✓CRA with CRA Tx Plan

✓Hand-articulated Study Casts

✓Properly Sequenced Phase 1, 2 and 3 (TPB Prep?) Plan/s


Tx

Treatment Plans & Checklists

1. TX Plan Phases - definitions

2. Phase 1 and 2

3. Phase 3

4. Implant Phase 3

5. Changing TX Plans

Treatment Plan Phases

•Phase 1 - Disease control, emergency care and preparatory steps. This phase would also include Periodontal treatment, necessary Consults or Exploratory

procedures (i.e. caries excavation) that would assist in the final diagnosis and treatment plan

for future phases.

•Phase 2 - Direct Restorative. This phase would also include bleaching trays,

preparation procedures for Phase 3 treatment plan, and may be the final Phase if no Indirect

restorations are indicated.

•Phase 3 - Indirect Restorative. This phase would include both Fixed and Removable

along with Implant placement and other surgical or specialty procedures that would directly

prepare a patient for other Phase 3 treatment.

• Implant Phase 3- This may include a limited implant TX plan - these plans need to be

approved by Fixed Prosthodontic Faculty at the DXR appointment

•NOTE: Often Phase 1 and 2 are combined as one plan. While this is often accomplished it is

necessary to ensure that the treatment is sequenced appropriately.

Tx

Phase 1 and 2

Preparatory and Direct Restorative

Tx Plan

Tx

Periodontal Phase 1

* D0180 - Periodontal Exam

D???? - Prophy

D???? - Fluoride

D???? - OHI

Direct Restorative Phase 2 When Phase 3 is indicated:

**D0003 - Operative Case Complete

D9430 - Office Visit - used for Occlusal Exam

D9450 - Extensive TX Planning

When Phase 3 is NOT indicated:

**D0005 - CDM Case Complete

(all treatment plans are completed OR patient

refuses to continue with approved TX plan)

*If a patient requires periodontal

procedures beyond an adult prophy

**See section on Case Completes

Phase 3 -

Indirect TX Plan

Tx

Surgical tx for Phase 3

care may be included in

these TX plans D0005 - CDM Case Complete

(all treatment plans are completed OR patient

refuses to continue with approved TX plan)

These plans will not be approved at

the DXR appointment!!!

Implant Phase 3

•ex - “ Implant Phase 3 #14”

Tx

*Implant Phase 3 plans

are approved by the Fixed

faculty at the DXR appt

These plans are limited in nature and only

recommended in certain cases when there are no

major oral diseases to control

An example of this plan may include a patient who

requires an implant in an ideal situation.

In order to get an 'Implant Phase 3' plan approved

at your DXR appt you must have a Tx plan ready

Having 'Implant Phase 3' plans help

expedite needed surgical referrals!

Treatment Plan CHANGES

•IF DURING YOUR TREATMENT THE PLAN CHANGES OR NEEDS

MODIFICATION...

-YOU MUST MAKE A NEW PLAN!!!

•THIS PLAN MUST BE APPROVED BY FACULTY AND PATIENT

•YOU DO NOT NEED TO GO BACK THROUGH DXR TO

MODIFY TX PLANS

Tx


Cc

Case Completes

1. D0003 Operative Case

Complete

2. D0003 Checklist

3. D0005 CDM Case Complete

4. D0005 Checklist

D0003 Operative Case Complete

D0003 - Dept Case Complete - used in Junior Clinic to

ensure all of the Phase 1 and 2 has been completed

Usually performed at the conclusion of the Direct Phase 1

and 2 Tx plan.

This must be completed before Phase 3 Indirect

Restorations are started

Cc

D0003 Operative Case Complete CHECKLIST

✓ Phase 1 and 2 have been completed

(including CRA TX - ie Fluoride varnishes)

✓ No Phase 1 or 2 treatment in the 'In-Progress' tab (unless

an approved note for the D0003 explains reason for leaving treatment, i.e. "Board lesion")

✓ Radiographs are current

✓Patient is Responding well to treatment and no other

Phase 1 and 2 care is required

Cc

D0005 Case Completes

D0005 - CDM Case Complete - used when all treatment is

rendered, or patient refuses care (must note).

This may require a separate appointment and additional

radiographs, usually performed with DXR faculty

This code should conclude all active care!!!

No treatment left in the 'In-Progress' tab

Cc

D0005 Case Complete

CHECKLIST ✓ ALL PHASES have been completed

(including CRA TX - ie Fluoride varnishes)

✓ No treatment present in the 'In-Progress' tab

✓All referrals in record have been addressed

✓ Radiographs are current

✓Patient is Responding well to treatment and no other

treatment is needed

Cc


Re

Referrals and

Consults

1. Guidelines for

Referrals/Consults

2. Implant Phase 3 Consults

REFERRAL AND CONSULTS

•Make sure the Referral and Consult (D9310) is also

appropriately phased in the TX plan as well

•For each referral generated, there should be an accompanying

Consult (D9310) in the treatment plan with the appropriate

Discipline listed

•Please make sure you complete the Referral prior to your DXR

appointment

•In certain cases the DXR faculty may not approve your referral

until you are at a specified point in your TX Plan Sequence (ie:

Implant placement)

Re

REFERRAL AND CONSULTS

Implant Phase 3 TX Plans

•Implant referrals go to Patient Services and they

determine where the implant is to be sent!

•Patient Services require a completed TX plan reflecting

the implant treatment (surgical and restorative) that has

been approved by the faculty and patient.

Re

dxr quick reference guide - augusta

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