dxr quick reference guide!

DXR Quick Reference Guide!

Ex! Re!Cc!Tx!Exams! Treatment !

Plans & Checklists!Case!

Completes!Referrals and!

Consults!�Click� one!

Ex!Exams!


1. Exam Types and Guidelines

2. New Patients/Transfer Patient

3. DXR Checklist

4. Transfer Patients (D0006)

5. Audits for Transfer Patients

6. Audit Form

7. Checklist for D0006

8. Guidelines for OME Consult

9. BW Frequency Guidelines

10. Recall (D0120) Exam Checklist

11. Comp (D0150) Exam Checklist

Ex!4 Basic Exam Types!

• D0120 - Periodic Exam - for patients who require a routine exam andhave been examined in the last 12-24 months!

• D0150 - Comprehensive Exam - for patients whose condition haschanged significantly and require a comprehensive exam or have not been examined in the last 24 months, also for new patients.!

• D0006 - Administrative Re-examination AND Chart Audit code - Use thiswhen a patient requires a re-examination (usually due to a transfer from another student/resident/faculty at GRU-CDM or an outside referral). This is a No-Charge exam and is to be performed on ALL transfer cases and Outside referrals. You may also approve a D0120 along with a D0006 if the patient is due for an exam. Again, ALL TRANSFER patients and DIRECT referrals require a D0006!!

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

Ex!Patient's First Appointments!

New Patients!!

3 Types of New Patients: !1. Standard !2. Special Screening !3. Direct Referrals (limited care)!• For a New Patient requiring Comprehensive care (excluding Completedentures) 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 aRemovable chair !

• Direct Referrals will be worked up in a Restorative chair just like a D0006!

Ex!

Patient's First Appointments!TRANSFER Patients!

!2 Types of TRANSFER Patients: !

1.  Seniors (or other CDM clinic) ! !2. Stand-by Patient!

Transfer patients will require a D0006 before definitive care is rendered. For Stand-by patients, on limited care for chief concern is delivered.!!Stand-by patients are for limited care assignment only and only limited care is provided. If Comprehensive care is needed to address chief concern then a tx plan is to be devised and the patient sent to Patient Services for counseling before treatment is rendered.!

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 2012 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 an 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, or the case is deemed too complex, 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 to 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 most current Treatment Plan/s!

� 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 and appropriate referrals/consults are entered!

Ex!D0006 – DETAILED Checklist!

!!!!!!!!!!!!

Ex!

Protocol for Medical History Update on D0006 Appointments!

!From the Department of Diagnostic Sciences!

!At the exam appointment, patients should have their medical history reviewed and approved by an ORAL MEDICINE faculty, if they!

!· Are an ASA III patient!· Have had a change in ASA status!· Have had a significant change in health history (i.e., hospitalization,

!surgery or new systemic disease diagnosis)!· Have had a significant change in medications!· Have a new oral mucosal lesion(s)!

Guidelines for OME Consult!!

Ex!Guidelines for Frequency of BW’s !

based on Caries Rate!!

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 with referrals/consults as needed!

Ex!!D0120 – Recall (Routine) Exam Checklist!

!

� Confirm Medical History!

� Oral Cancer Screen and Soft tissue exam!

� Updated BW’s (if needed) with Radiographic Interpretation!

� Caries identification, Review CRA and CRA TX progression!

� PSR!

� Review progression of Treatment plan!

Continued…!

!

Ex!!D0120 – Recall (Routine) Exam!

!Note for D0120 should be similar to the following:!

!Periodic Exam!RMH: changes listed!CC: list chief complaint!Exam: Intraoral soft tissue exam: _______________, OCS – neg(pos). Caries identified: (list areas), CRA reviewed, PSR: x-x-x/x-x-x. Consults needed: !!Films Needed: none (BW’s, PA #X etc)!!Treatment plan reviewed (and modified if needed)!!NV: ?!!If significant changes have occurred or the patient is due for FMX or Panorex then the patient requires a Comprehensive Exam (D0150). Significant changes include: Multiple new carious lesions (more than 3), PSR that necessitates full charting, and /or an addition of Phase 3 care to treatment plan. !

!!

Ex!D0150 Comprehensive Exam 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!

� New CRA with Caries management!

� Review prior TX Plans - make sure treatment has been followed as sequenced and appropriate referrals/consults are entered!

Ex!!!

D0150 – Comprehensive Exam!!

Note for D0150 should be similar to the following:!!

Comprehensive Exam!RMH: changes listed!CC: list chief complaint!Exam: Intraoral soft tissue exam: _______________, OCS – neg(pos). Caries identified: (list areas), PSR: x-x-x/x-x-x (or full mouth if needed). Consults needed: !!Odontogram reviewed and verified, CRA performed – (Caries Risk High, Moderate, Low etc). Caries management to include: (list strategies in general to deter cares). !!Films Needed: none (BW’s, PA #X, Pan, FMX etc)!!Treatment plan reviewed (and modified if needed)!!NV: ?!

!!

Tx!Treatment !

Plans & Checklists!


1. Tx Plan Phases – Definitions

2. Phase 1 and 2

3. Phase 3

4. Implant Phase 3

5. TPB Prep Plans

6. Changing TX Plans

7. Occlusal Plane Discrepancies

Treatment Plan Phases!• Phase 1 – Acute 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!D1110 - Prophy!D1204 - Fluoride!D1330 - 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 can be approved by 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 or occlusal plane discrepancies.!!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 Planning Board Prep TX Plans!

Tx!

Make sure your plans contain necessary codes for TX Planning Board!!

If you are required to go to TX Planning Board your patient may be

eligible some limited operative treatment prior to your TX Planning

Board Appointment.!Only limited operative care and

codes appropriate for TX Planning Board will be approved at your DXR

appointment!!

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#

Indirects and Occlusal Plane Discrepancies!

Tx!

If your patient requires Phase 3 and has an occlusal plane

discrepancy you need to refer to Dr. Chesla or Myers for pretreatment sequencing.!

Steps to Refer for Occlusal Plane Discrepancy:!

1.  Fill out a referral form in axiUm and put PROS as the department!

2.  Refer to Dr. Chesla or Dr. Myers!3.  Put reason for referral, “Occlusal Plane

discrepancy, please sequence”!4.  Add a D9310 (consultation) code to your

Phase 1 and 2 plan for this referral!5.  Get your referral completed before

beginning definitive care!

Do NOT begin restorative care until you treatment plan has been appropriately sequenced by Dr.

Chesla or Dr. Myers!!

Indirects and Occlusal Plane Discrepancies!

Tx!

In addition to the referral and consultation please have the following ready:!!

1.  Casts that have stable articulation (this may require you to mount your case)!

2.  A photograph like the one below that demonstrates the occlusal plane!


Cc!Case!

Completes!

1. D0003 Oper 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 or there is an approved explanation in the record as why tx was altered!(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!

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