Clinic Manual

H. Patient Administration

Admissions/Screening Policy

Subject: Clinical III. – H. Patient Administration

Department: Oncology and Diagnostic Sciences

Effective Date: 5/6/16

Reviewed and/or Revised: 09/01/2017

Additional Resource: Screening Flow Chart (PDF)

Policy and/or Procedure:

  1. The dental student will begin working up the screening patient during their block assignment. Patient will be assigned to a primary student provider preferably, the student who is performed the screening, as well as a secondary student provider for co-therapy if indicated. The dental student will complete and have a faculty approve the medical history form in EPR. All pertinent findings will be explained and detailed in the EPR.
  2. If indicated by the medical history, a medical consult form will be completed and approved by faculty in the EPR. This form will be printed and given to the patient to be completed by his/her physician, or the form can be emailed or faxed to the physician.
  3. The dental student will perform a thorough extra and intra oral examination on the patient and findings will be recorded and approved by a faculty in EPR. All lesions must be described using the drop down in the EPR. Findings can also be described on the diagram in EPR as well as an intraoral photo.
  4. Any patient with a lesion that warrants evaluation and/or follow up must be informed and referred to the oral medicine clinic. Appointments in the oral medicine clinic can be scheduled by calling 410-706-7956 or by emailing oralmedicine@umaryland.edu.
  5. Any patient that has an urgent need (pain, swelling, infection) must be referred as soon as possible for treatment. This may include a referral to oral surgery or endodontics. The appropriate referral to specialty clinic form must be completed and authorized in EPR.
  6. All appropriate radiographs must be planned in Axium by a faculty to be exposed by the student in MiPACS on each patient. All radiographs must be diagnostic and approved by a faculty member. If faculty deems it necessary, a panorex would be exposed in addition to the CRS. There are instances where a panorex and bitewings may be the standard of care.
  7. If the patient has had radiographs available from an outside office, the student should instruct the office to send the radiographs to oralrad@umaryland.edu. They will then be uploaded to MiPACS by the radiology staff. These radiographs need to be evaluated for diagnostic quality and any supplemental films need to be exposed at that point. See radiology section.
  8. The student will enter and have a faculty approve the appropriate screening and treatment planning macrocodes. 
  9. The patient assignment form will be completed and approved by a faculty member. This form will indicate if the patient should be assigned to a third year dental student, fourth year dental student, AGD resident, SCG clinic or post-graduate resident. The reason for referral to another clinic must be indicated on the patient assignment form. The patient care coordinator assigns the patient to the appropriate provider.
  10. If a student wants to screen their own patient, the patient can be registered and appointed in the predoctoral clinic.
  11. If a student does not report to block, he or she must make up two sessions for each one missed. A missed block will also result in a U grade in professionalism, which will have a negative impact on their Comprehensive Care and Patient Management course grade. If a student is not needed in the screening clinic, he/she must report to urgent care and/or oral surgery.

Each student must report to clinic on time. Tardiness is not accepted. If a student is late, they will receive an N grade in professionalism. If they are more than 15 minutes late, it constitutes a missed session and will result in a U grade for professionalism.

After Hours Access to Clinical Spaces Policy

Subject: III – Clinical – H. Patient Administration

Department: Clinical Affairs

Origination Date: December 1, 2023

Effective Date: December 1, 2023 

Review and/or Revise Date: N/A

Policy and/or Procedure:

To ensure building safety and minimize risk all dental chairs/units, unless specifically designated for emergency use, will be automatically turned off every evening 1.5 hours past the end of normal clinic hours, on weekends and during holiday breaks. All dental chairs/units will be turned on 1 hour before the start of normal clinic hours. 

Consequently, except for chairs specifically designated for emergency use, no students or residents should be in the clinical spaces during off hours. Students should only use clinical operatories that they have been designated for their program.
Please note, this does not apply to student/resident labs spaces. 

Clinics are only OPEN during the following hours:

General Practice Clinics, SC & G, and First Floor OMFS

  • Monday & Friday: 8am – 6pm
  • Tuesday & Thursday: 8am – 8pm
  • Wednesday: 6am – 6pm   

AEGD

  • Monday through Friday: 6:30am – 8pm

ASE Programs and PLUS Clinic

  • Monday through Thursday: 6:30am – 8pm
  • Friday: 6:30am – 6pm

Clinical operatories MAY NOT BE USED outside of these normal business hours.

    Appointment Recall Process (Pre-Doctoral Clinic) Policy

    Subject: III. Clinical – H. Patient Administration #2

    Effective Date: July 2016

    Reviewed and/or Revised: 12/05/2016, 09/01/2017

    Purpose: To ensure that the patient’s oral health is being properly maintained through appropriate recall intervals. Recall intervals are determined at the treatment planning appointments and/or the evaluation of initial periodontal therapy by the GP Director, Assistant GP Director, or Periodontal faculty. 

    Policy and/or Procedure

    Recall appointments are set in Axium according to their predetermined interval (3, 4, 6 months or 12 month denture recall). Students are expected to adhere to prescribed recall interval when possible. Reports can be queried to ensure that the indicated recall interval is being met. Some patients may require a customized recall strategy to ensure optimal oral health is being maintained. 

    Clinical courses including Comprehensive Care and Patient Management and Periodontics have certain requirements regarding recall status. Periodic chart audits are performed by the Patient Care Coordinators to ensure that the patients are being appointed appropriately for treatment. GP Directors and Assistant GP Directors periodically review patient lists with students to assure compliance to our recall policy.

    Auditing Patient Records Policy and Procedure

    Subject: III. Clinical – H. Patient Administration

    Origination Date: 01/01/2010

    Reviewed and/or Revised: 09/01/2016, 09/01/2017

    Purpose:

    To provide data as a basis for recommending approaches to problems and improving the overall operations of University of Maryland School of Dentistry (UMSOD).

    Policy and/or Procedure

    UMSOD will conduct objective and systematic audits using explicit criteria to assure that accepted business processes are followed, that the patient receives appropriate care, and the results of such audits shall guide actions to improve business practices, improve patient care, address organizational concerns, and correct other deficiencies.

    Director of Medical Credentialing runs monthly audit reports via the computer patient records system for unapproved or unsigned items such as consents, treatment plans and general policy and informed consent policy. Results of these audits are reported monthly to the Quality Assurance Committee.

    Booking an Appointment Pre-doctoral Dental and Dental Hygiene Students Procedure

    Subject: III. Clinical – H. Patient Administration

    Department: Periodontics/Dental Hygiene Division

    Effective Date: August 7, 2013

    Reviewed and/or Revised: 09/01/2017

    Purpose: To assist students regarding scheduling an appointment in Axium

    Policy and/or Procedure:

    Overall, requesting an appointment will be very similar to what you are currently doing. You will still have your chair assignments for the week, select a treatment to link to the appointment, and use the dropdown to select the appropriate treatment discipline. Colors will all remain the same. Here are the key changes:

    1. You will only be able to see 1 floor at a time on your “chair” view. In the bottom row of chairs, you will see each GP labeled and your chair reserves within that GP. In the top row, you will see the various treatment disciplines noted, and the faculty coverage listed on the bottom.
    2. Once you have used a chair reserve to book the appointment, it will be noted in the appropriate color in the bottom row within your GP. You must then click and drag the appointment and drop it into the appropriate place in the top row in order to reserve your spot.
    3. Your chair that you have selected in the top row will be your chair that you are to work in. There will be no more daily seating assignments, it will now be already noted on the chair view.
    4. Once the treatment discipline has been filled in the top row, YOU CANNOT BOOK ANOTHER CHAIR. Therefore, if there is “blank” box in the top row, it should remain empty.
    5. It is very important to use the “reason” section of your appointment request to write specifically what you are doing for that appointment. Do not just write “operative”. Write “#2 DO” or “#12 Post and Core”. Faculty coverage will be determined on a daily basis depending on the specific procedures.
    6. You will notice that each floor is symmetrical. On floor 2, GP’s 5 and 6 can book any of the chairs in the top left section for Treatment Planning and General Dentistry. GP’s 7 and 8 can book any of the chairs in the top right section for Treatment Planning and General Dentistry. Prosth is always in the second section (previously GP6), and Perio is always in the 3rd section (previously GP7). The specialties are now first come, first served for the entire floor. The layout is identical on the 3rd floor and the same booking rules apply.
    7. Any “GD” chairs noted that are not within the far top left and top right sections, are also “bonus” first come, first served chairs. You are able to book these across the floor as well. These are not available every session so look carefully.
    8. Below you will see an example. TP/GD are noted in the top left, and top right sections to be used by sister GP’s. Prosth is noted in the 2nd section. There are 6 “bonus” GD chairs covered by Dr. Freunlich in this section as well. These are available to the entire floor as stated above. All Perio are in the 3rd section. “PEF” denotes perio faculty (use the numbers on the bottom to book treatment plans and instrumentation the same way as before). “PEH” denotes hygiene, and “PER” denotes perio resident. The bottom row denotes each GP, and will show your chair reserves.
    9. “TP” chairs should be reserved for TPU’s and TXP’s. GD chairs should be used for operative, perio, prosth that you would do with GD, and TPW’s.
    10. If there is an opening on the opposite side of the floor for TP/GD, you may use the 48 hour rule to book after obtaining permission from the appropriate director. Example: If you are in GP 1 or 2, and you see an opening in GP’s 3/4 and it is within 48hrs, you may book there with permission. You can never switch floors.

    How to View and Read the Appointment Scheduler for Dental Hygiene Clinics

    The dental hygiene (2nd&3rd Floor) clinic book will display all 9 GPs within the Chair tab.

    Appointment Scheduler for Dental Hygiene Clinics

    The chairs within your GP will be color coded to define the reserve status and type of specialty appointments available.

    • Reserve Status
      • Green = Chair reserved for YOU (no appts) no appts or has appt has appt
      • Yellow = Chair within your GP is reserved for a student reserved for student
      • Blue or Salmon = Appt booked for a student booked for student;Appt last edited by student edited by student
      • White = Vacant GP# chair Vacant GP chair (NOT SOTD chairs ) Not SOTD chairs
        • When no appt < 48 hours,
        • Available for appt within your GP which must be made at the front desk
      • Grey = for information purposes for information purposes
        • Faculty coverage and maximum appts of attending slots
    • Example View

    Example View

    Q: How many Prosth appointments are available still?

    A: The schedule lists that the Prosth faculty can handle 3 Prosth appointments, but all 3 appointments have already been booked. No Prosth appointments are available.

    How to Make an Appointment for Dental Hygiene Clinics

    Beginning 7/22/13, to make an appointment in the Clinic the following steps must be followed:

    1. Within the Scheduler module, on the bottom, go to the day you’d like the schedule the appointment.

      Scheduler module
    2. Find your name on the green stamped chair within your GP.

      no appts
    3. After reviewing the faculty appointment coverage, click the Active tab on the right side.

      Active Appointments
    4. The yellow background color indicates the time available for the appointment. The appointment should begin at 9am (C1), 1pm (C2), or 4:30pm (C3). Click within the yellow background for applicable background.
    5. Select the patient from your patient list.

      patient list
    6. Enter the required appointment information.
      1. TX Discipline
      2. Appt. Status (aka specialty dept)
      3. Reason
      4. Note with details – (1) click the Notes button; (2) Enter the note content in the blank field; (3) click the Add/+ Folder button.

        creating an appointment
    7. Click the Accept button.
    8. There will now be a yellow floating appointment. Position the appointment over the clinic start time (9am - C1, 1pm - C2, or 4:30pm - C3) and double click. The appointment background will then change to the color of the type of specialty appointment you booked.

    At this point, everyone will be able to see that you have scheduled an appointment within your assigned chair, as well as what kind of appointment scheduled.

    Chart Documentation for Insurance Submission Procedure

    Subject: III. Clinical – H. Patient Administration

    Origination Date:

    Effective Date:

    Reviewed and/or Revised: 09/01/2017

    Purpose

    To ensure that much of the required information that has not been provided by the requestor of the pre-authorization is received. Also because many charts are kept out for extended periods of time and thus copies of charting can not be made, progress notes etc., that may be required as part of the claims submission are also received.

    Policy and/or Procedure

    1. All missing teeth numbers
    2. Dates of extractions (does not have to be the month, day, but definitely has to be a year, or the insurance company will continue to ask for it and we will never get it processed until we give them a year) of any extractions not done here.
    3. Actual teeth numbers for Osseous surgery, gingival flaps, alveoplastys, bone grafts. Insurance will not accept LL, LR, UR or UL anymore for these procedures, they keep coming back and asking for actual teeth numbers.
    4. Is it first time for crowns, implants, bridges etc?
    5. If not, what is the original date of placement for those procedures?
    6. Why are they being replaced if not first time?
    7. IF there is a crown being done and there is no endo on the tooth, insurance requires a narrative as to why a crown is being done without endo (if there is endo, this is not a problem)
    8. Are there pre-operative x-rays in Romexis? (most of the time, a pan or CRS is the best, but sometimes they do want pre-op periapicals of the tooth) We will print them, but we just need to make sure the provider knows this is needed so he/she can take one if needed.
    9. For veneers - a short narrative as to why they are being done and they ask for pre-op x-rays for that too.
    10. The pre-authorization has to be swiped into Axium.

    Also, they will not accept a pre-authorization that has alternate treatment plans (such as implants/denture) to see which one pays more. You can only send for one tx plan at a time. So if you got a denial for implants, then we could turn around and submit one for dentures, but never both together (if they encompass the same teeth, that is.)

    Clinic Fee Courtesies for Employees and Their Families

    Subject: Class III – Clinical – H. Patient Administration

    Policy Owner: Director of Finance

    Effective Date: July 1, 2023

    Reviewed and/or Revised: 07/01/2023

    Purpose

    The purpose of this policy is to allow special financial arrangements for employees and their families.

    Policy Statement

    School of Dentistry / UMFDSP Employee Fee Courtesy

    • For dental care regardless of type of employee.
      • This courtesy cannot be applied to procedures when insurance is used to pay for the procedure.
      • 20% fee reduction as a courtesy for all School of Dentistry / UMFDSP staff and their immediate family to include only their spouse and children.
      • The maximum annual accumulated courtesies are $2,000 per employee.

    Clinic Fee Courtesies for Students, Residents and Their Families

    Subject: Class III – Clinical – H. Patient Administration

    Policy Owner: Director of Finance

    Effective Date: July 1, 2023

    Reviewed and/or Revised: 07/01/2023

    Purpose

    The purpose of this policy is to allow special financial arrangements for students, residents and their families.

    Policy Statement

    Student Fee Courtesy

    • Educational fee courtesy for students treating students and their immediate family members.
      • Only allowed for patients who are DDS or DH students and their immediate family to include only their spouse, children, siblings, and parents.
      • Care must be provided by pre-doctoral DDS or DH students in the pre-doctoral clinic.
      • Patient will receive an 80% reduction of clinic fees exclusive of direct costs such as lab fees or clinic materials (e.g. bone graft, etc.).
      • Patient will be responsible for paying direct costs (e.g. lab fees or graft material).
      • Implants are not included in this program.

    Resident Fee Courtesy

    • Educational fee courtesy for residents treating their immediate family members.
      • Residents should meet with the program business manager about possible patient care fee reduction for treating their immediate family members. The program director must approve the courtesy based upon the program’s ability to cover the expense.

    Clinical Financial Management Policy - Predoctoral Clinics and AGD/ASE Clinics

    Subject: III. Clinical – H. Patient Administration

    Effective Date: July 20 2009

    Reviewed and/or Revised: 09/01/2017

    Policy Statement for Predoctoral Clinics

    All treatment must be paid in full at each treatment appointment unless a Patient Financial Agreement (contract) or other arrangements have been approved. If dental insurance, third-party coverage, or other prepaid financing covers the patient, pre-authorization approval must be obtained before treatment is initiated. A General Practice Director or Business Manager must approve exceptions to this policy. Typically, forty percent of the estimated total case fee must be collected at the time the Agreement is signed. Each student is responsible for overseeing patient compliance with the Agreement. The G.P. Director will be notified of each account that had a balance more than 60 days in arrears. Elective treatment may be discontinued, at the direction of the G.P. Director, for patients whose balance is unpaid or overdue for 60 days or more. Year IV students may not place active patients on a financial contract after February 1, in the year in which graduation is expected, unless approved in writing by a G.P. Director.

    Dental and dental hygiene students, their spouses and children are eligible for special fee reductions in the predoctoral program. Graduate students and Dental School employees may also qualify for fee reductions. Please refer to the policy below:

    Policy Statement for Advanced General Dentistry and Post-Graduate Clinics

    All treatment must be paid in full at each treatment appointment unless a Patient Financial Agreement (contract) or other arrangements have been approved. If dental insurance, third-party coverage, or other prepaid financing covers the patient, pre-authorization approval must be obtained before treatment is initiated. A Director or Business Manager must approve exceptions to this policy. Typically, thirty (30) percent of the estimated total case fee must be collected at the time the Agreement is signed and the balance to be paid over the estimated length of treatment. Each student is responsible for overseeing patient compliance with the Agreement. The Director will be notified of each account that had a balance more than 60 days in arrears. Elective treatment may be discontinued, at the direction of the Director, for patients whose balance is unpaid or overdue for 60 days or more.

    Dental and dental hygiene students, their spouses and children are eligible for special fee reductions in the predoctoral program. Graduate students and Dental School employees may also qualify for fee reductions. Please refer to the policy below:

    Clinic Missteps and Sanctions Policy

    Subject: Class III – Clinical – H. Patient Administration

    Department: Pre-Doctoral Clinics 

    Effective Date: 8/28/13

    Reviewed and/or Revised: 05/31/2016, 09/01/2017

    Click the following link to access a printable PDF of the UMSOD Student Responsibility Statement (PDF).

    Clinic Missteps and Sanctions

    Clinic Missteps Expected Sanctions
    Deliberate failure to follow faculty/auxiliary staff instruction in clinic: 1st offense -warning

    **2nd offense
    -Failing grade in Professionalism; failure for procedure; Academic Counseling Form
    Running over >20 minutes beyond scheduled clinic time: if a Time Mgt/Preparedness Issue: 1st offense -warning

    **2nd offense
    -Failing grade in Professionalism; failure for procedure

    **3rd offense
    - Failing grade in Professionalism; failure for procedure; and Academic Counseling Form
    Starting additional procedures without faculty authorization: 1st offense- warning

    **2nd offense
    -Failing grade in Professionalism; failure for procedure

    **3rd offense
    -Failing grade in Professionalism; failure for procedure; and Academic Counseling Form
    Patient dismissed from clinic before procedures and medical history are swiped into Axium without communicating with covering faculty (Swiping in treatment after the patient has left clinic): 1st offense –warning

    **2nd offense
    -Failing grade in Professionalism

    the procedure(s); Write a one page report on Accounts Receivable (A/R)
    Patient identifiers and/ or prescriptions left in clinic or other public areas of the building: Write a one page report on HIPAA regulations with copies to GP director, and vice-chair of the Department of General Dentistry.
    Failure to review medical history, take blood pressure, know drugs patient is taking, or ensure that medical consult has been returned and scanned into Axium: **1st offense- Failure in professionalism;

    Additional sanctions are at the discretion of the supervising faculty.
    Failure to know minimum basic information about the procedure to be performed: Student receives a “U” for procedure (sanction applied at the discretion of faculty). Student needs to submit written report detailing the armamentarium and step-by-step technique required for procedure.
    Treating patient without a “start”: **1st offense -U for professionalism and procedure Academic Counseling Form;
     
    1st offense
    for rising D3-Warning -at discretion of covering faculty
    Dismissing patient without a “final check”: 1st offense- warning

    **2nd offense
    -U for professionalism and procedure; Academic Counseling Form

    **3rd offense
    - U for professionalism and procedure; Academic Counseling Form; Judicial Board
    Student presents in inappropriate attire; does not follow school dress code: 1st offense - warning

    2nd offense
    -Student is dismissed from clinic
    Failure to present to a “Block” assignment. Late arrival or early departure to/from a block: 1st offense Repeat the Block + one additional Block; Academic Counseling Form;

    2nd offense
    3 day suspension in addition to repeat block+1.
    Bringing in a patient without an appointment in Axium - attempting to “add-on” w/o prior approval – scheduling pt. in wrong discipline: **One day clinic suspension*; Academic Counseling Form; Failing grade Professionalism/procedure(s)
    Bringing in a patient while scheduled on Block assignment: **Two and a half days of clinic suspension*; Repeat Block plus one; Academic Counseling Form; failing grade Professionalism/procedure(s)
    Juniors bringing in a patient to clinic during designated class time: **One day clinic suspension*; Academic Counseling Form; Failing grade in professionalism/procedure(s)
    Juniors/ Seniors bringing a patient to clinic when scheduled for senior case or translational conferences: **One day clinic suspension*; Academic Counseling Form; Failing grade professionalism and procedure(s)
    Performing treatment on a patient with a “frozen” account: At discretion of Director -One week clinic suspension*; Academic Counseling Form; Possible Judicial Board
    Performing treatment or scheduling a patient with an account balance > 60 days delinquent: One week clinic suspension*; Academic Counseling Form.
    Performing treatment without signed consent**: One wk. clinic suspension *; Academic Counseling Form; refer to Academic Dean; Judicial Board
    Performing prosthetic procedures without having completed the Pre-prosthetic Audit: **Academic Counseling Form; No credit for the prosthetic procedure; Failure Professionalism
    Failure to check in or check out the patient at the reception area: **One day clinic suspension, Failure in professionalism, Failure for procedure
    Failure to appoint patients/provide care in a timely manner within 3 weeks after assignment: **Failure in Professionalism; Academic Counseling Form; will affect CCPM grade
    Inappropriate attire in the clinic, whether treating a patient or not: Refer to school dress code; send student home
    Failure to obtain starting and finishing swipes as well as lab orders from the same faculty member: **Failure in professionalism/procedure; lab order does not receive a signature until the original faculty supervisor is present and is ready to sign.
    Seeing a patient in the clinic despite clinic suspension: Additional Clinic Suspension; refer to Dean of Academic Affairs; Judicial Board
    “Ghost Booking” and/or failure to cancel in Axium any patient who needs to reschedule; Scheduling > the allowed # of appointments for any patient: **Failure in Professionalism; 1 week clinic suspension; Academic Counseling form; Judicial Board Action
    Failure to return materials/equipment to Prep-Dispense at the end of session: Clinic Suspension of 1 – 5 days and academic counseling report at faculty discretion

    *Clinic Suspension: If you are suspended from clinic, you will not be allowed to see or treat your patients of record. You will however be assigned at the discretion of your GP Director or the Assistant Chair of General Dentistry’s (Dr. Larry Cohen) discretion to either:

    1. Be assigned to a Block based on operational need,
    2. Shadow a GP Director or clinic faculty for the day,
    3. Be assigned to assist another pre-doctoral student or AEGD resident in clinic.

    Failure to comply with clinic suspension will result in referral of the matter to the Judicial Board.

    **Affects CCPM grade- Any negative grade in Professionalism will be reflected in the CCPM grade as detailed in syllabus for CCPM.

    ***Signed Informed Consent (in Axium): Consent for treatment must be signed by the patient, in Axium, before any treatment is initiated! This refers to:

    1. All assigned comprehensive care patients
    2. Modification/Addendum to an existing treatment plan
    3. “Limited” or “Urgent Care” treatment plans

    The treatment plan must contain the appropriate codes, description (including materials to be used), and fee for that procedure. Each procedure is to be listed individually on the treatment plan (no bundling of codes). The treatment plan consent form must be signed by the patient, and subsequently the GP Director who evaluated the proposed treatment.

    I have read and understand the above mentioned clinic policies as relates to unacceptable behavior and expected sanctions:
    ____________________________________________ _________ _________ _____
    Student Name (Print & Signature) Student # Date GP

    Commercial Dental Insurance Policy

    Subject: Class III – Clinical – H. Patient Administration

    Effective Date: July 20 2009

    Reviewed and/or Revised: 09/01/2017

    Purpose

    To ensure that proper information is collected if the patient indicated that they carry dental insurance.

    Policy Statement

    Patients who indicate upon registration or at any time during the course of treatment that they carry dental insurance must provide a copy of their insurance card and the following information by completing the Insurance Information Form.

    Information needed: name of policy holder, group and policy identification numbers, employer data, insurance company data, dental benefit information, deductible amounts (if known), and effective policy date.

    The registrar reviews the employer data and checks it against our published employer data file. If there is no match, all information is forwarded to the Business Office for inclusion in the Insurance/Employer database.

    The patient must provide the insurance office with a copy of their company's insurance form at the initiation of care and each new calendar year with all pertinent employee and patient information provided. The form must also contain the patient's signature authorizing submission and designation to pay benefits.

    For patients whose treatment plan exceeds $250.00, a preauthorization request must be forwarded to the insurance company for determination of benefits. When presenting the record for preauthorization to the insurance clerk, the following must be present:

    Completed treatment plan (signed by patient and faculty); completed dental charting including pocket depth readings and with all missing teeth crossed out; and appropriate radiographic images. Provider should indicate whether the proposed bridges or prosthetic appliance(s) are initial or replacement devices. If appropriate, indicate the age of existing prosthesis and the reason for replacement.

    Treatment should not commence until a confirming authorization has been received. A duplicate copy of the authorization will be forwarded to the provider of care for information purposes and discussion with the patient of their finical obligation for those services not covered by insurance.

    As treatment is completed, the insurance form will be executed as part of the charge out procedure. Providers are requested to advise the insurance clerk when prosthetic devices have been delivered so he/she may complete the preauthorization form and forward it for payment.

    The business Office will post all insurance payments directly to the patient account.

    Any inquiries received by our office for additional information from the insurance carrier may be forwarded to the provider of service for appropriate response. All requests should be returned to the Business Office within 5 working days.

    Consents Policy and Procedure – Initial Consent (SC & G)

    Subject: Class III – Clinical – H. Patient Administration

    Department: Special Care and Geriatrics Clinic / Department of Periodontology

    Origination Date: 7/31/15

    Effective Date: 7/31/15

    Reviewed and/or Revised: 09/01/2017

    Purpose: To ensure that prior to providing non-emergency oral health care services to a patient, informed consent is obtained from the patient if the patient is capable of making an informed decision, or a legal guardian or individual authorized to make health care decisions for the patient.

    Definitions:

    Legal Guardian: An individual appointed by the court through a guardianship proceeding to make decisions on behalf of a person who has been certified incapable of making their own informed decisions.

    Patients may be incapable of making their own informed decisions due to intellectual disabilities or for other reasons. Consent from a legal guardian or individual authorized to make health care decisions for the patient is required before such patients may receive care.

    Policy and/or Procedure:

    At the time of scheduling an appointment, all patients will be asked to identify whether they are capable of making their own informed decisions, or whether they have a legal guardian or an individual who is authorized to make health care decisions on their behalf. Documentation of guardianship is required.

    An Informed Consent form(s) signed by the legal guardian or an individual authorized to make health care decisions for the patient must be in the record before the patient can receive any services in the Clinic.

    Creating a Payment Plan Policy and Procedure

    Subject: Class III – Clinical – H. Patient Administration

    Effective Date: July 21 2009

    Reviewed and/or Revised: 09/01/2017

    Policy Statement

    Patients to go on a payment for planned treatment.

    Purpose

    To have payment before treatment for lab fees.

    Definitions

    Contract/financial agreement - a binding agreement between two or more persons or parties; especially: one legally enforceable b: a business arrangement for the supply of dental services at a fixed price.

    Policy and/or Procedure

    Discuss contract, down payment, timeframe and with patient in order to arrive at the terms of the financial contract.

    Establish down payment and plan timeframe.

    Enter information into patient record via computer program. Note: information will not be in the patient record chart.

    Dispensing Preventive Products Procedure

    Subject: Class III – Clinical – H. Patient Administration

    Department: All Clinical Departments

    Origination Date: January 27, 2016

    Effective Date: February 1, 2016

    Reviewed and/or Revised: 09/01/2017

    Purpose: To dispense preventive products at the UMSOD to our patients in lieu of having patients have to go to their pharmacy—if they so desire.

    Scope (applies to): Dental and Dental Hygiene Students/Faculty

    Definitions: Prescription products such as MI Paste, MI Paste Plus, Prevident 5000 Plus, Chlorhexidine

    Policy and/or Procedure:

    • Provider/faculty use existing drug selection list to order Rx (current protocol)
    • Use the approved printed prescription from Axium – this ensures data is in Axium under the patients EPR as prior.
    • Print prescription and have the covering dentist sign it.
    • If patient elects to fill the prescription at the School Store, student will take the prescription and money from patient to School Store Manager (Mr. Ernest Leivers). School Store Manager (Mr. Ernest Leivers) will take money and Rx paperwork. School Store Manager (Mr. Ernest Leivers) will then give the student the product to give to the patient along with a receipt.
    • Mr. Leivers will keep a list on file of the following information and submit a copy to Dr. Leventer for records purposes:
      • Date of Prescription
      • Name of Patient
      • Name of Provider prescribing
      • Name of Student
      • Name of product prescribed
      • Price charged to patient
      • Date prescription is given to student to give to patient

    Fees:

    • Prevident 5000 Plus: $4.00
    • MI Paste products: $7.99
    • Chlorhexidine: Small Bottle, $3.50, Large bottle, $5.50

    Entering Treatment into Axium

    Subject: Class III – Clinical – H. Patient Administration

    Reviewed and/or Revised: 09/01/2017

    Purpose

    Support policies: Patient Care Finances, Record treatment planned and/or delivered

    Policy and/or Procedure

    1. For treatment as planned performed by student

    1. Student opens screen
    2. Student selects planned treatment
    3. Student changes status from "In process" to "Complete"
    4. Faculty swipes-approves to complete

    2. Definition of Successful Execution

    1. Student opens screen
    2. Student selects planned treatment
    3. Student deletes planned treatment
    4. Student adds new treatment
    5. Faculty swipe-approves deleted treatment and completed treatment

    Definition of Successful Execution

    This procedure step has concluded successfully when Faculty swipe-approves deleted treatment and completed treatment

    Definition of Successful Execution

    This procedure step has concluded successfully when Faculty swipes-approves to complete

    3. For treatment with minor change performed by student

    1. Student opens screen
    2. Student selects planned treatment
    3. Student deletes planned treatment
    4. Student adds new treatment
    5. Faculty swipe-approves deleted treatment and completed treatment

    Definition of Successful Execution

    This procedure step has concluded successfully when Faculty swipe-approves deleted treatment and completed treatment

    4. For new treatment performed by student Treatment Planning.

    5. To Delete treatment performed by student

    1. Student opens screen
    2. Student selects treatment
    3. Student deletes treatment
    4. Faculty swipe-approves deleted treatment

    Definition of Successful Execution

    This procedure step has concluded successfully when Faculty swipe-approves deleted treatment

    To All Students/Residents/Faculty:

    The Dental School is taking an important step in moving towards more complete and accurate chart notes.

    Effective 7/11/16, all residents and pre-doc students will be required to select the name of the “Covering Faculty” for all procedures. For faculty performing a procedure, they are to select their own name.

    Notes can be created in several ways:

    1. Note manually typed freehand via Template Notes

    Select Tx History tab

    Tx History Tab

    1. Click on the “add a new note” symbol (second green PLUS sign)
    2. A box will pop up; click on the square next to CODE
    3. This will give the dropdown list of type of template notes to select from

    Clinical Note Codes List

    “General Note” or “SOAP/ATEN Note”

    To enter the note, click on {*Required} which will bring up

    Template Note- Patient

    Clinical Note Codes List

    Enlarged Template Note-Patient

    Click on Covering Faculty {*Required}, type first character of last name then select from the dropdown list of faculty.

    2. Note via multi-disciplinary VISIT form.

    1. Appointment Provider must add the form. Go to Forms tab , click on “add a new record” icon
    2. An “Add Form” box will pop up; click on the dropdown list in “Form” and select the “VISIT Form ” and hit “ok”
    3. This “Visit Form” is a fill-in-the-blank / dropdown multidisciplinary question set that automatically creates a progress note. After the form is reviewed and approved, the progress note is added to the patient’s chart under the Tx History tab.

      **A Built in option for addendum and/or corrections to this note is available when you scroll down to the bottom of the Visit Form.

    For additional information and an online demo of the complete process for creating a progress note using the VISIT form, access “Visit Form Progress Note” via Axium Links

    Thank you for your anticipated cooperation!

    Fee Schedule

    Subject:  Class III – Clinical – H. Patient Administration

    Reviewed and/or Revised: 09/01/2017

    Code AxiUm Description AGD ASE FDS FDS+ PV SC&G / PLUS BASE
    C1000 Positional Conditions 0 0 0 0 0 0 0
    C2000 Orientation Conditions 0 0 0 0 0 0 0
    C2004 Diasthemas 0 0 0 0 0 0 0
    D0110.1 Medical History Analysis 0 0 0 0 0 0 0
    D0110.2 Soft Tissue Exam 0 0 0 0 0 0 0
    D0110.3 Hygiene Assessment 0 0 0 0 0 0 0
    D0120 Periodic oral evaluation 53 53 53 53 36 35 35
    D0120.1 Endo Recall Performed 0 0 0 0 0 0 0
    D0120.2 Annual Periodontal Evaluation 0 0 0 0 0 0 0
    D0140 Limited oral eval-prob focused 74 74 79 85 56 64 64
    D0145 ORAL EVAL.PATIENT UNDER 3YRS 60 60 70 75 49 35 35
    D0150 Comprehensive oral evaluation 89 89 94 104 65 69 69
    D0150.1 BOARDS ONLY Screening 0 0 0 0 0 0 0
    D0160 Detailed & extensive oral eval 134 155 162 178 83 101 84
    D0170 Re-eval-limited-prob focused 20 20 30 50 20 20 20
    D0170.1 Patient Therapy Complete 0 0 0 0 0 0 0
    D0170.2 EIT Periodontal Case 0 0 0 0 0 0 0
    D0170.3 Scaling Complete or Competency 0 0 0 0 0 0 0
    D0170.5 Pre-Prosth Audit 0 0 0 0 0 0 0
    D0170.8 EIT Gingivitis Case 0 0 0 0 0 0 0
    D0170.9 Geriatric CCare Outcome Assmt 0 0 0 0 0 0 0
    D0171 Re-evaluation - post-operative office visit 27 27 37 42 22 15 15
    D0180 Comprehensive perio evaluation 89 95 100 110 52 63 53
    D0180.2 Referral to Perio Sophomore block 0 0 0 0 0 0 0
    D0180.3 Localized Periodontal Evaluation 0 0 0 0 0 0 0
    D0210 Intraoral-complete series 130 130 130 130 130 130 130
    D0220 Intraoral-periapical 1st image 27 27 27 27 27 27 27
    D0230 Intraoral-periapical addl film 23 23 23 23 23 23 23
    D0240 Intraoral - occlusal film 37 37 37 37 37 37 37
    D0250 Extraoral radiographic images 51 51 51 51 51 51 51
    D0251 Extra-oral posterior radiograph 44 44 44 44 44 44 44
    D0270 Bitewing - single film 27 27 27 27 27 27 27
    D0272 Bitewing - 2 films 33 33 33 33 33 33 33
    D0273 Bitewing - 3 films 39 39 39 39 39 39 39
    D0274 Bitewing - 4 films 45 45 45 45 45 45 45
    D0277 Vertical bitewing - 7-8 films 85 85 85 85 85 85 85
    D0290 Post.-ant. Skull & facial bone 112 112 112 112 112 112 112
    D0310 Sialography 233 233 233 233 233 233 233
    D0320 TMJ arthrogram, incl injection 473 473 473 473 473 473 473
    D0321 Other TMJ films, by report 164 164 164 164 164 164 164
    D0330 Panoramic film 85 85 85 85 85 85 85
    D0340 Cephalometric radiograph 2D 108 108 108 108 108 108 108
    D0350 Oral/facial images 0 0 0 0 0 0 0
    D0364 Cone Beam CT - less than one jaw w interpretat 209 209 209 209 209 209 209
    D0365 Cone Beam CT - mandible with interpretation 296 296 296 296 296 296 296
    D0366 Cone Beam CT - maxilla with interpretation 296 296 296 296 296 296 296
    D0367 Cone Beam CT - maxilla & mandible w interpret 366 366 366 366 366 366 366
    D0368 Cone Beam CT for TMJ series incl 2 /more expo 275 275 275 275 275 275 275
    D0391 Interpretation of diagnostic image including rep 108 108 108 108 108 108 108
    D0393 Treatment simulation using 3D image interpret 128 128 128 128 128 128 128
    D0395 Fusion of 2+ 3D image volumes of one or more 128 128 128 128 128 128 128
    D0415 Bact. studies for path. agents 180 180 180 198 129 109 96
    D0416 Viral Culture 151 151 151 151 123 80 80
    D0417 Collection/prep of saliva sample for lab testing 111 125 153 178 95 83 83
    D0418 Analysis of saliva sample 110 124 152 177 95 81 81
    D0422 Collect/prep genetic sample for lab analysis/rep 112 112 112 112 95 62 62
    D0423 Genetic test for disease susceptibility/specime 112 112 112 112 95 62 62
    D0425 Caries susceptibility tests 93 93 93 102 69 57 57
    D0431 Adj.Pre-Diag Test/Not Biop/Cyt 73 73 73 81 57 44 44
    D0460 Pulp vitality tests 60 60 61 67 31 34 34
    D0470 Diagnostic casts 116 116 116 116 76 63 63
    D0471 Oral Pathology Laboratory 0 0 0 0 0 0 0
    D0472 Accession of tissue-gross exam 117 117 117 117 83 63 63
    D0473 Accession of tissue 151 151 151 151 118 80 80
    D0474 Accession of tissue, w/ assess 182 182 182 182 131 96 96
    D0475 Decalcification Proc. 209 209 209 209 143 110 110
    D0476 Spec. Stains Microorganisms 305 305 305 323 217 171 171
    D0477 Spec. Stns. Not Microorganisms 314 314 314 328 219 173 173
    D0478 Immunohistochemical Stains 169 169 171 171 123 120 120
    D0479 Tissue In-Situ Hybridization 233 233 240 263 166 130 130
    D0480 Process & interp-cytol. smears 178 178 178 182 123 96 96
    D0481 Electron Microscop-Diag. 175 175 206 227 131 96 96
    D0482 Direct Immunofluorescence 104 104 110 121 79 59 59
    D0483 Indirect Immunoflurescence 120 120 131 144 93 68 68
    D0484 Consult on slides Elsewhere 164 164 178 195 121 89 89
    D0485 Consult.Incl. Prep of Slides 170 170 195 211 123 93 93
    D0486 Accession of Brush Biopsy, sample Micro. Exam 164 164 164 175 112 87 87
    D0502 Other oral pathology proc. 175 175 175 192 129 118 98
    D0601 Caries risk assessment and documentation - low 0 0 0 0 0 0 0
    D0602 Caries risk assessment and documentation - mo 0 0 0 0 0 0 0
    D0603 Caries risk assessment and documentation - hig 0 0 0 0 0 0 0
    D0999 Unspecified Diagnostic Procedure by report 0 0 0 0 0 0 0
    D1110 Prophy - adult 97 97 97 107 72 66 66
    D1120 Prophy - child 73 73 73 78 52 46 44
    D1208 Topical application of fluoride 40 40 40 44 29 25 25
    D1310 Nutritional counseling 0 0 0 0 33 0 0
    D1320 Tobacco counseling 0 0 0 0 0 0 0
    D1330 Oral hygiene instructions 0 0 0 0 0 0 0
    D1351 Sealant - per tooth 59 59 59 64 40 36 32
    D1352 Preventative Resin Restoration 86 86 105 115 84 86 86
    D1353 Sealant repair - per tooth 0 0 0 0 0 0 0
    D1354 Interim caries arresting medicament application 41 41 41 49 29 25 25
    D1510 Space maint - fixed-unilateral 335 335 335 368 172 229 187
    D1515 Space maint - fixed-bilateral 451 451 451 496 232 320 293
    D1520 Space maint - remov-unilateral 416 416 416 451 213 284 237
    D1525 Space maint - remov-bilateral 510 510 510 561 266 364 291
    D1550 Re-cementation of space maint 89 89 89 95 45 59 48
    D1555 Removal of Fixed Space Maintainer 85 85 86 94 43 47 47
    D2140 Amalgam - 1 surface 92 113 150 167 81 73 73
    D2150 Amalgam - 2 surfaces 118 147 187 207 103 90 90
    D2160 Amalgam - 3 surfaces 147 178 228 240 119 113 113
    D2161 Amalgam - 4 or more surfaces 171 211 265 287 134 134 134
    D2330 Resin-based comp-1 surf, ant. 112 136 175 187 98 85 85
    D2331 Resin-based comp-2 surf, ant. 139 170 216 237 117 109 109
    D2332 Resin-based comp-3 surf, ant. 170 209 258 281 145 132 132
    D2335 Resin-based comp-4+surf, ant. 215 261 327 346 175 166 166
    D2390 Resin-based comp crown, ant. 313 381 469 505 232 232 232
    D2391 Resin-based comp-1 surf, post. 125 153 191 216 108 100 100
    D2392 Resin-based comp-2 surf, post. 166 203 247 272 140 122 122
    D2393 Resin-based comp-3 surf, post. 207 252 306 337 174 152 152
    D2394 Resin-based comp-4+surf, post. 244 294 365 387 187 188 188
    D2410 Gold foil - 1 surface 403 494 594 632 387 322 322
    D2420 Gold foil - 2 surfaces 448 548 680 693 442 378 378
    D2430 Gold foil - 3 surfaces 525 643 792 866 512 436 436
    D2510 Inlay - metallic - 1 surface 566 692 851 894 547 413 411
    D2520 Inlay - metallic - 2 surfaces 618 752 930 970 601 459 459
    D2530 Inlay - metallic - 3 or more 673 821 1020 1109 645 494 492
    D2542 Onlay - metallic - 2 surfaces 709 865 1044 1143 666 515 515
    D2543 Onlay - metallic - 3 surfaces 727 887 1075 1183 695 534 528
    D2544 Onlay - metallic - 4 or more 750 915 1151 1266 721 557 546
    D2610 Inlay - porc/cer - 1 surface 625 764 943 1006 602 462 455
    D2620 Inlay - porc/cer - 2 surfaces 693 846 1020 1077 642 501 501
    D2630 Inlay - porc/cer - 3 or more 730 890 1050 1131 683 529 529
    D2642 Onlay - porc/cer - 2 surfaces 746 910 1088 1186 692 546 540
    D2643 Onlay - porc/cer - 3 surfaces 774 944 1134 1229 716 560 560
    D2644 Onlay - porc/cer - 4 or more 796 971 1177 1245 744 584 576
    D2650 Inlay - resin - 1 surface 599 733 902 949 561 435 435
    D2651 Inlay - resin - 2 surfaces 636 774 930 997 590 460 460
    D2652 Inlay - resin - 3 or more 678 829 983 1076 621 492 492
    D2662 Onlay - resin - 2 surfaces 699 854 994 1093 639 506 506
    D2663 Onlay - resin - 3 surfaces 714 871 1031 1130 662 518 518
    D2664 Onlay - resin - 4 or more 746 909 1071 1178 683 540 540
    D2710 Crown - resin (indirect) 620 749 930 965 457 446 446
    D2740 Crown - porcelain/ceramic subs 809 982 1222 1286 770 590 583
    D2750 Crown - PFM high noble metal 782 959 1204 1346 571 571 571
    D2751 Crown - PFM predom. base metal 714 882 1110 1169 525 525 525
    D2752 Crown - PFM noble metal 755 920 1157 1275 548 548 548
    D2780 Crown - 3/4 cast high noble mt 782 959 1184 1302 737 571 571
    D2783 Crown - 3/4 porcelain/ceramic 809 982 1180 1286 749 590 583
    D2790 Crown -Full cast high noble mt 782 959 1219 1378 571 571 571
    D2791 Crown -Full cast pred base mtl 714 882 1089 1208 525 525 525
    D2792 Crown -Full cast noble metal 755 920 1157 1289 548 548 548
    D2799 Provisional Crown 288 352 447 481 282 209 209
    D2910 Recement Inlay 77 96 121 125 61 62 62
    D2915 Recement Cast/Prefab P&C 80 99 120 125 61 64 64
    D2920 Recement crown 77 96 119 125 61 62 62
    D2921 Reattachment of tooth fragment, incisal edge o 58 66 86 96 43 43 43
    D2930 Prefab SS crown - prim. tooth 195 239 287 315 179 151 151
    D2931 Prefab SS crown - perm. tooth 237 288 339 373 209 185 185
    D2932 Prefab resin crown 251 304 372 410 192 193 193
    D2933 Prefab SS crown - resin window 264 322 383 421 192 204 204
    D2940 Sedative filling 80 99 129 145 64 64 64
    D2949 Restorative foundation for an indirect restorati 144 164 180 198 108 109 109
    D2950 Core buildup - including pins 197 241 288 316 149 154 154
    D2951 Pin retention - per tooth 48 58 78 86 37 37 37
    D2952 Cast post and core 305 374 444 488 228 275 275
    D2954 Prefab post and core 246 297 366 403 187 190 190
    D2955 Post removal 214 260 312 343 159 165 165
    D2957 Addl prefab post - same tooth 110 135 166 169 124 83 83
    D2960 Labial veneer, resin-chairside 424 520 652 693 324 322 322
    D2961 Labial veneer, resin-lab 662 807 993 1025 480 480 480
    D2962 Labial veneer, porcelain-lab 763 932 1189 1256 568 554 554
    D2971 Add'l Procedures to Construct New Crn Under E 120 120 180 188 97 80 80
    D2975 Coping - Cvring of tooth 421 513 631 665 402 320 320
    D2980 Crown repair 203 247 305 337 155 156 156
    D2981 Inlay repair of restorative material failure 203 247 285 313 145 156 156
    D2982 Onlay repair of restorative material failure 203 247 282 311 144 156 156
    D2983 Veneer repair of restorative material failure 203 247 298 328 151 156 156
    D2990 Resin infiltration of incipient smooth lesions 125 141 168 185 108 100 100
    D2999 Unspecified Restorative Procedure, by report 50 50 50 50 86 47 47
    D2999.1 Surveyed to Crown Lab Fee 46 46 85 85 45 45 45
    D2999A Porcelain Butt Margin Lab Fee (Crown) 36 36 36 36 35 35 35
    D3110 Pulp cap - direct 58 71 89 98 45 45 45
    D3120 Pulp cap - indirect 58 71 89 98 45 45 45
    D3220 Therapeutic pulpotomy 141 173 211 232 109 110 110
    D3221 Pulpal debridement, prim/perm 155 188 238 265 120 120 120
    D3222 Partial Pulp. for Apexogenesis-pmnt tth w/inco 223 223 311 339 158 172 172
    D3230 Pulpal therapy - ant, primary 189 232 287 315 147 148 148
    D3240 Pulpal therapy - post, primary 221 271 320 352 165 172 172
    D3310 Endo therapy - anterior 519 631 810 891 373 373 373
    D3320 Endo therapy - bicuspid 613 748 912 1003 425 449 425
    D3330 Endo therapy - molar 749 915 1098 1208 509 509 509
    D3331 Endo-Rt canal obstruc-non surg 328 401 495 532 284 278 278
    D3332 Endo-Incompl inop/fract tooth 295 361 449 472 285 230 230
    D3332.1 ENDO-INCOMP(PT.DID NOT RTN) 295 361 445 452 266 230 230
    D3333 Endo - internal root repair 192 235 311 333 203 150 150
    D3346 Endo retreatment - anterior 599 731 923 1015 461 463 463
    D3347 Endo retreatment - bicuspid 688 838 1036 1139 525 533 533
    D3348 Endo retreatment - molar 816 995 1234 1358 624 632 632
    D3351 Apex/recalc - initial visit 140 172 211 264 93 93 93
    D3352 Apex/recalc-interim med replac 84 104 127 159 56 56 56
    D3353 Apex/recalc - final visit 252 310 380 476 167 167 167
    D3355 Pulpal regeneration – initial visit 140 172 211 264 93 93 93
    D3356 Pulpal regeneration – interim medication replac 84 104 127 159 56 56 56
    D3357 Pulpal regeneration – completion of treatment 252 288 288 316 166 167 167
    D3410 Apicoectomy - anterior 476 579 749 828 368 368 368
    D3421 Apicoectomy - bicusp(1st root) 538 656 813 880 416 418 418
    D3425 Apicoectomy - molar (1st root) 621 759 939 1033 479 482 482
    D3426 Apicoectomy - addl roots 254 312 390 415 232 197 197
    D3427 Periradicular surgery without apicoectomy 386 386 386 570 379 381 381
    D3428 Bone graft in conjunction with periradicular sur 173 173 208 277 173 173 173
    D3429 Bone graft w/periradicular surg–each adl tooth 173 173 208 277 173 173 173
    D3430 Retrograde filling - per root 192 237 293 322 149 150 150
    D3431 Biologic mat soft and osse tiss regen w/periradi 329 403 418 460 322 256 256
    D3432 Guided tiss regen resorb barr, per site w/perira 293 293 476 524 293 293 293
    D3450 Root amputation - per root 350 424 513 564 411 270 270
    D3470 Intentional reimplantation 592 725 848 933 426 459 459
    D3910 Surg isolate of tth,rubber dam 141 173 226 255 141 111 111
    D3920 Hemisection, incl root removal 329 403 495 544 256 256 256
    D3950 Canal prep with dowel or post 182 222 268 295 170 141 141
    D3999 Unspecified endo procedure 0 0 0 0 123 0 0
    D4000 Surgical Services 0 0 0 0 0 0 0
    D4000.1 Surgical Workup-Part C 0 0 0 0 0 0 0
    D4000.2 Performance of Surgery 0 0 0 0 0 0 0
    D4000.3 Post Surgical Evaluation & Sum 0 0 0 0 0 0 0
    D4000.4 Surgical Assist 0 0 0 0 0 0 0
    D4000.5 Interactive Surgical Assist 0 0 0 0 0 0 0
    D4200.2 Bone Screw & Tack 87 87 87 89 89 89 89
    D4210 Gingivectomy/plasty -4 of more 454 555 665 732 340 353 353
    D4211 Gingivectomy/plasty - 1-3 tth 202 247 291 353 161 182 182
    D4212 Ginigivectomy or gingivoplasty for restoration p 202 233 241 265 122 123 123
    D4230 Anatom.Crn.Exp. 4 or More TTH 433 528 650 664 363 337 337
    D4231 Anatom.Crn Expo. 1-3 TTH 413 502 622 661 317 319 319
    D4240 Gingival flap - 4 of more/quad 536 653 782 861 405 416 416
    D4241 Gingival flap - 1-3 teeth/quad 452 552 650 715 335 352 352
    D4245 Apically positioned flap 638 776 847 932 569 494 494
    D4249 Clinical crown elong, hard tis 547 668 803 884 413 423 423
    D4260 Osseous surgery-4 or more/quad 770 938 1128 1240 582 593 593
    D4261 Osseous surgery - 1-3 tth/quad 638 777 931 1024 469 495 495
    D4263 Bone Repl Graft - first site 173 173 208 277 173 173 173
    D4263.1 Bone Replacement Material 398 398 402 530 0 0 0
    D4263.2 Bio oss 2.0c/4.2ccbone 438 438 442 449 0 0 0
    D4264 Bone Repl Graft - add'l site 173 173 208 277 173 173 173
    D4265 Biologic materials-tissue regn 329 403 511 520 322 256 256
    D4265.1 Osteocel 1 cc 0 959 0 0 0 0 0
    D4266 Guided tissue regen-resorb-incl barrier 293 293 312 342 293 293 293
    D4267 Guided tissue regen-nonresorb-no barrier 293 293 312 342 293 293 293
    D4268 Surg. revision proc. - per tth 595 726 834 917 550 459 459
    D4270 Pedicle soft tissue graft 603 736 869 956 446 468 468
    D4273 autogenous connective tissue graft, first site in 780 953 1115 1227 574 582 577
    D4274 Distal or proximal wedge 500 610 697 766 461 371 371
    D4275 non-autogenous connective tissue graft, first sit 731 891 1037 1140 666 538 538
    D4276 Comb. connective tissue/graft 825 1009 1151 1266 744 610 610
    D4277 free soft tissue graft (recipient & donor sites); fi 642 784 967 1040 497 497 497
    D4278 Free soft tissue graft (recipient & donor sites); a 214 260 323 346 250 166 166
    D4283 Autogenous connective tissue graft, each addtl 391 477 582 623 289 291 289
    D4285 non-autogenous connective tissue graft, each a 391 477 582 623 289 291 289
    D4320 Provisional Splint Intracoronal 368 449 546 601 282 286 286
    D4321 Provisional Splint Extracoronal 329 403 501 551 255 256 256
    D4341 Scaling/rt planing 4 or more 186 223 275 303 86 137 77
    D4342 Scaling/rt planing 1-3 teeth 118 146 189 220 63 85 48
    D4355 Full mouth debridement 137 166 195 214 115 106 106
    D4381 Antimicrobial Agent- per site 69 69 92 101 62 68 68
    D4910 Periodontal maintenance 100 121 146 161 78 78 78
    D4920 Unscheduled dressing change 73 89 110 112 56 59 59
    D4921 Gingival irrigation – per quadrant 13 15 23 25 10 10 10
    D4999 Unspecified periodontal proc. 0 0 0 0 46 0 0
    D5110 Complete denture - maxillary 1174 1439 1775 1907 848 848 848
    D5120 Complete denture - mandibular 1174 1439 1775 1933 848 848 848
    D5130 Immediate denture - maxillary 1267 1556 1925 2078 915 915 915
    D5140 Immediate denture - mandibular 1267 1556 1925 2078 915 915 915
    D5211 Max. part denture - resin base 499 607 732 805 461 602 361
    D5212 Mand Part denture - resin base 499 607 732 805 461 602 361
    D5213 Max partial - cast metal frame 1216 1488 1879 1959 882 875 875
    D5214 Mand partial -cast metal frame 1216 1488 1879 1959 884 875 875
    D5221 Immediate maxillary partial denture – resin bas 849 1048 1297 1519 658 617 617
    D5222 Immediate mandibular partial denture – resin b 849 1048 1297 1519 665 617 617
    D5223 Immediate maxillary partial denture – cast met 1338 1637 2066 2155 971 962 962
    D5224 immediate mandibular partial denture – cast m 1338 1637 2066 2155 973 962 962
    D5225 Max Partial Dent. Flex Base 539 647 782 865 501 608 401
    D5226 Mand. Partial Dent. Flex Base 539 647 782 865 501 608 401
    D5410 Adjust complete denture - max 62 77 95 105 48 48 48
    D5411 Adjust complete denture - mand 62 77 95 105 48 48 48
    D5421 Adjust partial denture - max 62 77 95 105 48 48 48
    D5422 Adjust partial denture - mand 62 77 95 105 48 48 48
    D5510 Repair denture base 149 181 228 251 115 134 134
    D5520 Replace teeth - per tooth 121 160 202 223 103 104 104
    D5610 RPD:Resin denture base 156 176 220 242 112 120 120
    D5620 RPD:Cast framework 216 259 308 338 158 174 165
    D5630 RPD:Repair or replace broken clasp per tooth 189 233 286 314 147 148 148
    D5640 RPD:Broken teeth - per tooth 128 154 202 226 100 100 100
    D5650 RPD:Add tooth - existing partial 162 192 241 265 121 122 122
    D5660 RPD:Add clasp - existing partial per tooth 189 233 282 311 147 148 148
    D5670 RPD:Replace all teeth - max 507 648 751 832 471 384 384
    D5671 RPD:Replace all teeth - mand 507 648 751 832 471 384 384
    D5700 Denture Rebase Procedures 0 0 0 0 0 0 0
    D5710 Rebase complete max. denture 424 520 628 690 317 329 329
    D5711 Rebase complete mand. denture 424 520 628 690 318 329 329
    D5720 Rebase max. partial denture 404 497 612 673 307 315 315
    D5721 Rebase mand. partial denture 404 497 606 666 307 315 315
    D5730 Reline comp max - chairside 269 331 400 440 205 211 211
    D5731 Reline comp mand - chairside 269 331 396 436 203 211 211
    D5740 Reline max part - chairside 269 331 385 423 246 211 211
    D5741 Reline mand part - chairside 269 331 390 429 250 211 211
    D5750 Reline comp max - laboratory 351 423 498 548 257 270 270
    D5751 Reline comp mand - laboratory 351 423 507 558 259 270 270
    D5760 Reline max part - laboratory 351 423 502 552 256 270 270
    D5761 Reline mand part - laboratory 351 423 502 552 256 270 270
    D5810 Interim complete denture - Max 608 673 835 938 557 426 408
    D5811 Interim complete denture -Mand 608 673 835 938 557 426 408
    D5820 Interim partial denture - Max 499 607 732 805 461 361 361
    D5821 Interim partial denture - Mand 499 607 732 805 461 361 361
    D5850 Tissue conditioning - Max. 141 173 213 235 106 106 106
    D5851 Tissue conditioning - Mand. 141 173 212 234 106 106 106
    D5862 Precision attachment 486 486 751 826 465 287 287
    D5862.1 Prec.Attach. Locator 0 0 0 0 0 0 0
    D5863 Overdenture - Complete Maxillary 1194 1459 1815 1967 868 868 868
    D5864 Overdenture - Partial Maxillary 1236 1508 1919 2019 902 895 895
    D5865 Overdenture – complete mandibular 1194 1459 1815 1993 868 868 868
    D5866 Overdenture – partial mandibular 1236 1508 1919 2019 904 895 895
    D5867 Replace, part of semi-prec att 262 325 366 388 228 242 242
    D5867.1 Replace Locator Male 50 50 50 50 50 50 50
    D5875 Mod of rem prosth after implnt 262 326 402 455 253 234 234
    D5899 Unspec removable prosth proc. 397 459 588 647 313 315 315
    D5913 Nasal Prosthesis 2401 2782 3810 4001 1905 1905 1905
    D5914 Auricular prosthesis 2400 2452 3808 3999 1904 1904 1904
    D5932 Obturator prosthesis - def. 0 2076 2396 3465 0 0 0
    D5933 Obturator prosthesis - mod. 0 388 443 493 0 0 0
    D5936 Obturator prosthesis - int. 0 1051 1051 1801 0 0 0
    D5953 Speech aid prosthesis - adult 0 1428 2515 2772 0 0 0
    D5955 Palatal lift prosthesis - def. 0 1166 2993 3465 0 0 0
    D5958 Palatal lift prosthesis - int. 0 0 0 0 0 0 0
    D5982 Surgical stent 296 364 460 510 282 231 231
    D5986 Fluoride gel carrier 141 166 212 239 135 106 106
    D5988 Surgical splint 567 684 787 865 529 408 408
    D5991 Topical Medicament Carrier 141 166 212 255 135 106 106
    D5992 Adjust Maxillofacial Prostethic Appl, by report 65 70 92 107 50 45 45
    D5993 Maint/Cleaning of Maxillofac Prosth, by report ( 11 11 11 11 10 10 10
    D5994 Periodontal medicament carrier w/peripheral s 215 245 326 359 164 164 164
    D5999 Unspecified max. prosthesis 564 653 854 939 445 447 447
    D6010 Surg placement, endosteal impl 950 950 1650 2272 950 950 950
    D6010.3 STAGE 2 IMPLANT SURGERY 0 0 0 0 0 0 0
    D6011 Second stage implant surgery 192 218 291 321 146 146 146
    D6012 Surg Plcmnt Intrm Endo Implt 410 410 1230 1330 410 410 410
    D6013 Surgical placement of mini implant 500 500 965 1003 500 500 500
    D6040 Surg placement, eposteal impl 6017 7381 7934 8727 5538 4593 4593
    D6050 Surg placemnt, transosteal imp 4132 5068 5633 6196 3793 3154 3154
    D6051 Interim abutment includes placement & remov 288 352 434 466 282 209 209
    D6052 Semi-precision attachment abutment 473 476 745 783 521 279 279
    D6053.2 Retrofit Denture to Impl 608 718 889 904 549 455 455
    D6055 Dental implant supported bar 1821 2067 2720 3465 1924 1308 1308
    D6056 Prefabricated abutment 300 300 600 660 200 200 200
    D6057 Custom abutment 400 400 800 1036 300 300 300
    D6057.0 Custom Abutment (Implant Crown) 527 588 936 1031 379 350 350
    D6057.1 Custom Abutment-Titanium 554 619 1012 1134 499 371 371
    D6057.2 Custom Abutment-Zirconium 554 619 1012 1134 499 371 371
    D6058 Abut supported - porc/ceramic crown 958 1081 1463 1643 970 705 700
    D6059 Abutment - PFM,high noble metl 959 1123 1497 1668 978 696 696
    D6060 Abutment - PFM, based metal 886 1036 1328 1565 902 642 642
    D6061 Abutment - PFM, noble metal 921 1081 1386 1553 940 667 667
    D6062 Abutment-cast metal,high noble 959 1123 1498 1648 978 696 696
    D6064 Abutment-cast metal,noble metl 921 1081 1387 1553 940 667 667
    D6065 Implant - porc/ceramic crown 993 1164 1579 1737 1014 720 720
    D6065.2 Implant Retained Temporary 247 247 252 252 125 125 125
    D6066 Implant - PFM,high noble metal 959 1123 1598 1758 752 696 696
    D6067 Implant -metal crwn,high noble 959 1123 1555 1760 767 696 696
    D6068 Abutment-retainer,porc/cer FPD 993 1164 1522 1674 1014 720 720
    D6069 Abutment-ret,PFM FPD,high nobl 959 1123 1490 1682 978 696 696
    D6070 Abutment-ret,PFM FPD,base metl 886 1036 1424 1587 902 642 642
    D6071 Abutment-ret,PFM FPD,noble met 921 1081 1443 1588 940 667 667
    D6072 Abut-ret,cast metal-high noble FPD 959 1123 1497 1693 978 696 696
    D6073 Abut-ret,cast metal-base metal FPD 886 1036 1368 1587 902 642 642
    D6074 Abut-ret,cast metal-noble metl FPD 921 1081 1429 1595 940 667 667
    D6075 Implant -retainer for cer. FPD 958 1164 1497 1650 1040 705 700
    D6076 Implant - retainer for PFM FPD 958 1123 1568 1650 1043 714 714
    D6077 Implant - ret, cast metal FPD 958 1123 1599 1767 1069 714 714
    D6080 Implant maintenance proc. 195 239 296 296 196 151 151
    D6090 Repair implant -prosthesis 539 663 785 863 509 401 401
    D6091 Replace Implt Supptd Attachmen 135 135 220 296 112 112 112
    D6092 Recement Implt Supp Crn 108 133 164 181 111 83 83
    D6093 Recement Implt Supp FPD 108 133 176 207 120 83 83
    D6095 Repair implant abutment 539 663 753 828 499 401 401
    D6100 Implant removal by report 567 684 795 874 520 421 414
    D6100.1 Implant Removal by Rpt 0 0 0 0 0 0 0
    D6101 debride of a periimpl defect of exp imp surf incl 452 552 583 641 297 352 352
    D6102 debrid oss contr periimplant defect; inc surf exp 582 661 826 909 439 441 441
    D6103 bone graft for repair of periimplant defect – w/ 173 173 208 277 309 173 173
    D6104 bone graft at time of implant placement 173 173 202 277 173 173 173
    D6110 Impl/Abut Supported Remv Denture Edentulou 1274 1539 2144 2216 948 948 948
    D6111 Impl/Abut Supported Remv Denture Edentulou 1274 1539 2144 2216 948 948 948
    D6112 Impl/Abut Supported Remv Dent Part Edentulo 1316 1588 2036 2216 982 975 975
    D6113 Impl/Abut Supported Remv Dent Part Edentulo 1316 1588 2036 2216 984 975 975
    D6114 Hybrid4 Impl/Abut Supported Fixd Denture Ede 5829 6240 6240 6864 8405 8446 8446
    D6115 Hybrid4 Impl/Abut Supported Fixd Denture Ede 5829 5987 5987 6586 8405 8446 8446
    D6116 Hybrid4 Impl/Abut Supported Fixd Dent Part Ed 4526 4526 4526 4979 7354 7390 7390
    D6117 Impl/Abut Supported Fixd Dent Part Edentulous 4771 4771 4771 5248 7354 7390 7390
    D6190 Radio/Surg Implt Index(stent)by rpt 370 370 418 460 317 198 182
    D6190.1 Nobelbiocare Stent 431 601 610 622 427 427 427
    D6199 Unspec. implant proc by report 304 353 464 506 240 241 241
    D6205 Pontic Indirect Resin Bds Com 742 909 1020 1122 683 536 536
    D6210 Pontic - cast high noble metal 782 959 1187 1317 748 566 566
    D6211 Pontic - cast predom base metl 714 882 1077 1134 702 520 520
    D6212 Pontic - cast noble metal 755 920 1128 1189 723 542 542
    D6240 Pontic-porc fuse to high noble 782 959 1187 1329 763 566 566
    D6241 Pontic-porc fuse to base metal 714 882 1107 1217 714 520 520
    D6242 Pontic-porc fuse to noble metl 755 920 1140 1267 733 542 542
    D6245 Pontic-porcelain/ceramic 809 982 1205 1325 770 590 576
    D6250 Pontic-resin, high noble metal 782 959 1151 1266 755 566 566
    D6251 Pontic-resin, predom base metl 714 882 1089 1214 711 520 520
    D6252 Pontic-resin with noble metal 755 920 1128 1240 722 542 542
    D6253 Provisional pontic 320 320 770 847 205 205 205
    D6545 Retainer, metal, resin bond FP 539 663 817 938 531 393 393
    D6548 Retainer, porc/cera, bonded FP 708 829 994 1093 668 492 492
    D6549 Resin retainer - for resin bonded fixed prosthes 539 663 817 938 531 393 393
    D6600 Inlay - porc/ceramic, 2 surf 748 913 1024 1126 683 549 543
    D6601 Inlay - porc/ceramic, 3+ surf 806 982 1102 1213 723 587 584
    D6602 Inlay - high noble mtl, 2 surf 767 936 1056 1162 704 560 555
    D6603 Inlay - high noble mtl, 3+ sur 820 1003 1086 1194 741 595 595
    D6604 Inlay - pred. base mtl, 2 surf 732 893 1004 1105 670 531 531
    D6605 Inlay - pred. base mtl, 3+ sur 784 957 1046 1151 719 573 570
    D6606 Inlay - cast noble mtl, 2 surf 753 918 1031 1134 683 550 547
    D6607 Inlay - cast noble mtl, 3+ sur 801 979 1062 1168 722 589 582
    D6608 Onlay - porc/ceramic, 2 surf 806 982 1121 1233 722 587 584
    D6609 Onlay - porc/ceramic, 3+ surf 878 1071 1182 1300 785 650 637
    D6611 Onlay - high noble mtl, 3+ sur 896 1094 1203 1323 794 657 650
    D6720 Retainer Crown - resin, high noble metl 782 959 1098 1208 722 571 571
    D6721 Retainer Retainer Crown - resin, predom base m 714 882 1089 1163 684 525 525
    D6722 Retainer Crown - resin, noble metal 755 920 1107 1217 702 548 548
    D6740 Retainer Crown - porcelain/ceramic 809 982 1211 1332 770 590 583
    D6750 Retainer Crown Porcelain fused - high noble 782 959 1204 1346 750 571 571
    D6751 Retainer Crown - porcelain to base metl 714 882 1109 1225 686 525 525
    D6752 Retainer Crown - porcelain to noble mtl 755 920 1153 1268 719 548 548
    D6783 Retainer Crown - 3/4 porcelain/ceramic 809 982 1180 1301 756 590 583
    D6790 Retainer Crown-full cast high noble mtl 782 959 1192 1328 737 571 571
    D6791 Retainer Crown-full cast pred. base mtl 714 882 1098 1208 683 525 525
    D6792 Retainer Crown - full cast noble metal 755 920 1134 1265 711 548 548
    D6793 Provisional retainer crown 329 403 496 612 321 240 240
    D6900 Other FPD Services 0 0 0 0 0 0 0
    D6900.1 Clips (Hader bar) 96 96 114 160 100 100 100
    D6900.2 Replace Prosth. Screw 96 96 114 160 100 100 100
    D6900.3 Replace Locator or ERA male 0 67 82 112 0 0 0
    D6920 Connector bar 730 882 1086 1149 674 648 648
    D6930 Recement FPD 115 146 183 201 89 89 89
    D6940 Stress breaker 296 364 431 474 282 231 231
    D6950 Precision attachment 473 573 690 759 442 364 364
    D6980 FPD repair 269 331 408 451 260 211 211
    D6999 Unspecified fixed pros. proc. 156 180 247 259 123 123 123
    D6999 A Porcelain Butt Margin Lab Fee (Bridge) 0 0 0 0 0 0 0
    D6999.1 $50 Add'tl Dental Lab Cost for Prosth Procedure 50 50 50 50 50 50 50
    D6999.2 $100 Add'tl Dental Lab Cost for Prosth Procedu 100 100 100 100 100 100 100
    D6999.3 $105 Add'tl Dental Lab Cost for Prosth Procedu 105 105 105 105 105 105 105
    D6999.4 $250 Add'tl Dental Lab Cost for Prosth Procedu 250 250 250 250 250 250 250
    D6999.5 $315 Add'tl Dental Lab Cost for Prosth Procedu 315 315 315 315 315 315 315
    D6999.6 $500 Add'tl Dental Lab Cost for Prosth Procedu 500 500 500 500 500 500 500
    D6999.7 $750 Add'tl Dental Lab Cost for Prosth Procedu 750 750 750 750 750 750 750
    D6999.8 $1000 Add'tl Dental Lab Cost for Prosth Proced 1000 1000 1000 1000 1000 1000 1000
    D6999.9 $1200 Add'tl Dental Lab Cost for Prosth Proced 1200 1200 1200 1200 1200 1200 1200
    D7111 Coronal remnants - decid. tth 96 114 144 159 73 74 74
    D7140 Extraction, eruptd tth/ exp rt 114 138 175 208 118 86 86
    D7210 Surg removal of erupted tooth 195 208 298 328 174 145 133
    D7220 Rem of impacted tth, soft tiss 227 259 339 373 168 174 148
    D7230 Rem of impacted tth, part bony 288 298 424 466 245 214 174
    D7240 Rem of impacted tth, comp bony 375 375 513 564 321 263 231
    D7241 Rem of impacted tth, surg comp 424 520 589 648 481 401 401
    D7250 Removal of residual tth roots 217 265 324 357 165 169 169
    D7260 Oroantral fistula closure 534 650 804 925 499 414 414
    D7261 Primary closure of sinus perf. 523 642 787 818 403 408 408
    D7270 Tooth reimplantation/stabilize 386 472 584 648 300 301 301
    D7272 Tooth transplantation 494 605 740 804 385 386 386
    D7280 Surg exposure - ortho reasons 338 418 514 555 428 258 258
    D7282 Mobilization of tth for erupt 377 460 523 575 332 269 269
    D7283 Plcmt device facil. eruption 393 478 511 563 347 290 290
    D7285 Biopsy of oral tissue - hard 276 336 420 495 215 215 215
    D7286 Biopsy of oral tissue - soft 217 265 337 389 267 169 169
    D7287 Cytology sample collection 104 126 175 219 90 80 80
    D7288 Brush biopsy transepithelial 118 146 183 230 94 90 90
    D7290 Surgical reposition of teeth 341 414 519 571 267 269 269
    D7291 Transseptal fiberotomy 217 265 317 349 209 167 167
    D7292 Sur.Plcmt Tmp Anch. Flap(plt& 1797 2206 2719 3046 2151 1399 1399
    D7293 Surg.plcmt tmp anchor w/flap 500 500 1633 1663 500 500 500
    D7294 Surg Plcmt Tmp Anch. w/o Flap 500 500 1253 1273 500 500 500
    D7295 Harvest of Bone (autogenous grafting) 319 386 435 479 230 245 245
    D7310 Alveoloplasty with extractions 208 254 313 349 160 161 161
    D7311 Alveoplasty w/1-3 ext.per quad 226 278 314 345 160 176 176
    D7320 Alveoloplasty w/o ext 4 tth sp 301 364 454 511 231 231 231
    D7321 Alveoplasty not w/1-3 ext quad 319 386 435 479 230 245 245
    D7330 Vestibuloplasty 0 0 0 0 0 0 0
    D7340 Vestibuloplasty - second epith 702 850 1048 1109 591 593 593
    D7350 Vestibuloplasty -tissue grafts 1374 1654 2041 2078 1193 1001 1001
    D7410 Excision, benign lesion<1.25cm 285 332 428 476 213 213 213
    D7411 Excision, benign lesion>1.25cm 425 520 628 690 326 328 328
    D7412 Excision, ben lesion complicat 564 684 845 859 454 456 456
    D7413 Excision, malig lesion>1.25cm 474 581 714 811 466 399 399
    D7414 Excision, malig lesion>1.25cm 710 869 967 1109 683 596 596
    D7415 Excision, malig lesion complic 871 973 1191 1280 810 666 666
    D7425 Removal, Tumor, Cyst, Neoplasm 0 0 0 0 0 0 0
    D7440 Exc malign tumor-lesion<1.25cm 394 574 786 825 393 393 393
    D7441 Exc malign tumor-lesion>1.25cm 708 1015 1391 1460 695 695 695
    D7450 Rem odonto cyst/tumor < 1.25cm 359 438 544 574 313 313 313
    D7451 Rem odonto cyst/tumor > 1.25cm 459 561 714 811 426 428 428
    D7460 Rem nonodonto cyst < 1.25cm 365 446 549 588 307 309 309
    D7461 Rem nonodonto cyst > 1.25cm 494 605 745 832 472 475 475
    D7465 Destruction of lesion 244 295 375 429 249 188 188
    D7470 Excision of Bone Tissue 0 0 0 0 0 0 0
    D7471 Removal of lateral exostosis 449 548 680 739 347 347 347
    D7472 Removal of torus palatinus 528 645 797 870 410 410 410
    D7473 Removal of torus mandibularis 525 643 790 832 408 408 408
    D7485 Surg reduct of osseous tuberos 474 576 712 812 367 367 367
    D7490 Resection, mandible-bone graft 5945 5945 7941 8552 5382 4072 4072
    D7510 Incision/drainage,abscess-intr 162 198 247 285 126 126 126
    D7511 I&D intraoral sft tiss. compl. 220 270 337 390 222 172 172
    D7520 Incision/drainage,abscess-extr 269 331 408 472 240 241 241
    D7521 I&D extraoral sft tiss compli. 350 424 524 588 400 324 324
    D7530 Removal of foreign body/skin 251 290 371 408 241 195 195
    D7540 Removal-musculoskeletal system 467 531 678 746 362 364 364
    D7550 Part. stectomy/sequestrectomy 368 440 523 588 300 301 301
    D7560 Max. sinusotomy - removal 810 992 1225 1374 734 630 630
    D7610 Maxilla - open reduction 3045 3735 4505 4956 2861 2369 2369
    D7620 Maxilla - closed reduction 2413 2957 3475 3912 2253 1876 1876
    D7630 Mandible - open reduction 3048 3737 4611 5166 2905 2372 2372
    D7640 Mandible - closed reduction 2352 2886 3559 3959 2221 1832 1832
    D7650 Malar/zygo arch - open reduct 2739 3362 3983 4381 2522 2132 2132
    D7660 Malar/zygo arch -closed reduct 2253 2764 3343 3677 2102 1755 1755
    D7670 Alveolus - closed reduction 961 1172 1446 1473 882 745 745
    D7671 Alveolus - open reduction 607 744 916 1028 681 472 472
    D7680 Facial bones-complicatd reduct 4565 5601 6910 7741 4294 3553 3553
    D7710 Maxilla - open reduction 3175 3894 4607 5067 3071 2470 2470
    D7720 Maxilla - closed reduction 2372 2910 3552 3907 2306 1846 1846
    D7730 Mandible - open reduction 3364 4125 5088 5702 3146 2616 2616
    D7740 Mandible - closed reduction 2535 3107 3700 4070 2408 1971 1971
    D7750 Malar/zygo arch - open reduct 2895 3551 4282 4711 2820 2254 2254
    D7760 Malar/zygo arch -closed reduct 3357 4116 5077 5690 3210 2612 2612
    D7770 Alveolus - open reduction 1892 2321 2843 3127 1798 1472 1472
    D7771 Alveolus - closed reduction 1189 1458 1798 2014 1154 926 926
    D7780 Facial bones-complicatd reduct 5655 6936 8558 9520 5390 4400 4400
    D7810 Open reduction of dislocation 2983 3659 4513 5001 2815 2321 2321
    D7820 Closed reduction of dislocatio 402 495 610 682 391 314 314
    D7830 Manipulation under anesthesia 536 656 809 907 544 418 418
    D7840 Condylectomy 3756 4605 5680 6258 3490 2922 2922
    D7850 Surg discectomy w/ w/o implant 3775 4631 5490 6039 3612 2938 2938
    D7852 Disc repair 3961 4860 5773 6350 3744 3084 3084
    D7854 Synovectomy 3911 4799 5702 6439 3651 3045 3045
    D7856 Myotomy 2473 3036 3699 4069 2351 1926 1926
    D7858 Joint reconstruction 0 0 0 0 0 0 0
    D7860 Arthrotomy 0 0 0 0 0 0 0
    D7865 Arthroplasty 0 0 0 0 0 0 0
    D7870 Arthrocentesls 288 354 436 490 301 223 223
    D7871 Non-arthroscopic lysis, lavage 0 0 0 0 0 0 0
    D7872 Arthroscopy-diag w/ w/o biopsy 0 0 0 0 0 0 0
    D7873 Arthroscopy-surg:lavage,lysis 0 0 0 0 0 0 0
    D7874 Arthroscopy-surg:disc repositn 0 0 0 0 0 0 0
    D7875 Arthroscopy - surg:synovectomy 0 0 0 0 0 0 0
    D7876 Arthroscopy - surg:discectomy 0 0 0 0 0 0 0
    D7877 Arthroscopy - surg:debridement 0 0 0 0 0 0 0
    D7880 Occlusal orthotic device 662 869 946 1040 618 662 662
    D7881 Occlusal orthotic device adjustment 152 190 233 364 141 119 119
    D7899 Unspecified TMD therapy 0 0 0 0 0 0 0
    D7910 Suture of recent small wounds 212 257 316 347 160 161 161
    D7911 Complicated suture - up to 5cm 326 384 505 556 305 263 263
    D7912 Complicated suture - > 5cm 473 575 709 824 481 366 366
    D7915 Other Repair Procedures 0 0 0 0 0 0 0
    D7920 Skin Graft 1704 2091 2578 2888 1725 1328 1328
    D7921 Col/app of Autologous bld conc (PRP) 513 513 513 513 513 513 513
    D7940 Osteoplasty-orthognath deforms 2579 3165 3905 4375 2517 2007 2007
    D7941 Osteotomy - mandibular rami 6637 8141 9414 10355 6138 5163 5163
    D7943 Osteotomy - mand rami w/ graft 6637 7492 8732 9605 5733 4753 4753
    D7944 Osteotomy - segment/subapical 4925 6044 7142 7856 4719 3835 3835
    D7945 Osteotomy - body of mandible 5008 6146 7429 8244 4650 3896 3896
    D7946 LeFort I - max. total 5907 7247 8940 9957 5457 4598 4598
    D7947 LeFort I - max. segmented 6148 7541 9100 10010 5751 4785 4785
    D7948 LeFort II/III - w/o bone graft 7008 8595 10438 11506 6580 5454 5454
    D7949 LeFort II/III - w/ bone graft 8237 10052 11920 12630 7493 6378 6378
    D7950 Oss.,ost., or cart graft, mand 1845 1845 2588 2847 1756 1667 1667
    D7951 Sinus Aug. w/bone or sub. 1713 2092 2980 3133 2106 1328 1328
    D7952 Sinus Aug-vertical approach 940 1122 1334 1467 667 702 702
    D7953 Bone replcmt graft ridge site 173 173 556 612 173 173 173
    D7955 Repair - max. tissue defect 2073 2402 2529 2782 1637 1645 1645
    D7960 Frenulectomy - separate proc. 324 395 471 518 240 251 251
    D7963 Frenuloplasty 356 436 530 598 328 276 276
    D7970 Excision - hyperplastic tiss 359 438 525 578 274 278 278
    D7971 Excision - pericoronal gingiva 169 208 274 311 132 132 132
    D7972 Surg reduct, fibrs. tuberosity 519 631 733 807 389 401 401
    D7980 Sialolithotomy 483 591 730 817 485 376 376
    D7981 Excision of salivary gland 0 0 0 0 0 0 0
    D7982 Sialodochoplasty 1200 1474 1818 2004 1134 936 936
    D7983 Closure of salivary fistula 872 1072 1321 1481 865 681 681
    D7990 Emergency tracheotomy 906 1110 1370 1534 903 704 704
    D7991 Coronoidectomy 2784 3413 4151 4566 2645 2167 2167
    D7995 Synthetic graft - mand/face 0 0 0 0 0 0 0
    D7996 Impant-mand. - augmentation 0 0 0 0 0 0 0
    D7997 Appliance removal, w/ archbar 197 241 305 407 200 154 154
    D7998 Intraoral Plcmt Fixation Device Not in Conj. w/F 1474 1806 2227 2496 1538 1147 1147
    D7999 Unspecified oral surgery proc. 132 154 210 220 106 106 106
    D8010 Limited ortho - primary 1395 1680 2255 2490 1015 1015 1015
    D8010.6 Limited ortho - primary 6 Month Treatment 0 705 1130 1245 705 0 0
    D8010.C Limited ortho - primary 12 Month Treatment 0 1200 2255 2490 1015 0 0
    D8020 Limited ortho - transitional 1490 2100 2510 2760 1015 1105 1105
    D8020.6 Limited ortho - transitional 6 Month Treatment 0 705 1260 1395 705 0 0
    D8020.C Limited ortho - transitional 12 Month Treatmen 0 1200 2515 2785 1015 0 0
    D8030 Limited ortho - adolescent 1785 2185 2920 3210 1015 1305 1305
    D8030.6 Limited ortho - adolescent 6 Month Treatment 0 705 1460 1615 705 0 0
    D8030.C Limited ortho - adolescent 12 Month Treatmen 0 1200 2925 3230 1015 0 0
    D8040 Limited ortho - adult 1785 2310 3140 3475 1015 1320 1320
    D8040.6 Limited ortho - adult 6 Month Treatment 0 910 1575 1735 910 0 0
    D8040.C Limited ortho - adult 12 Month Treatment 0 1500 3140 3475 1015 0 0
    D8050 Interceptive ortho - primary 1680 1680 2595 2865 1335 1305 1305
    D8060 Interceptive ortho-transitionl 1965 2100 2740 3030 1495 1455 1455
    D8060.1 Reduced transitional orthodontics 340 340 99999 99999 99999 99999 99999
    D8070 Comprehensive ortho-transition 3720 3720 5255 5805 3710 3080 3050
    D8070.3 Bands Placed 0 0 0 0 0 0 0
    D8080 Comprehensive ortho - adolesce 3720 3720 5460 6005 3500 3135 3095
    D8080.3 Bands placed 0 0 0 0 0 0 0
    D8080.4 Active treatment complete 0 0 0 0 0 0 0
    D8090 Comprehensive ortho - adult 4175 4175 5455 6025 3870 3315 3275
    D8090.3 Bands placed 0 0 0 0 0 0 0
    D8090.4 Active treatment complete 0 0 0 0 0 0 0
    D8090.5 Comprehensive ortho - adult Extensive Treatme 0 4875 7130 8175 4260 0 0
    D8210 Removable appliance therapy 620 745 885 980 470 460 460
    D8220 Fixed appliance therapy 705 865 995 1095 515 535 535
    D8660 Pre-ortho Treatment Visit (Records) 318 318 461 651 318 318 318
    D8660.1 Pedo/Ortho Screening Visit 0 0 0 0 0 0 0
    D8660.2 Ortho Screening Visit 0 0 0 0 0 0 0
    D8660.3 Ortho Tx Plan Presentation 0 0 0 0 0 0 0
    D8660.4 Ortho/OS Case Conference 0 0 0 0 0 0 0
    D8670 Periodic ortho treatment visit 0 0 0 0 0 0 0
    D8680 Orthodontic retention 0 0 495 545 240 0 0
    D8681 Removable orthodontic retainer adjustment 152 190 233 364 141 119 119
    D8690 Orthodontic treatment 0 0 290 320 150 0 0
    D8691 Repair of ortho appliance 155 190 225 250 145 125 125
    D8692 Replace - lost/broken retainer 225 225 330 360 170 210 210
    D8692.1 Replace lost/broken ESSIX 105 105 135 0 0 55 55
    D8693 Rebond.,recem.,rep.,fixed ret 155 160 325 360 170 125 125
    D8694 Repair of fixed retainers, includes reattachment 152 190 206 227 141 119 119
    D8999 Unspecified ortho procedure 0 0 148 164 70 0 0
    D8999.1 Copyplast/ESSIX retainer,vac. fab. 0 103 132 169 68 68 68
    D8999.3 Ceramic bracket surcharge 0 264 270 270 223 223 223
    D8999.4 Invisalign in add to comp adult ortho 0 908 0 0 0 0 0
    D8999.5 Harmony in add to comp ortho 1739 1739 1689 1689 1739 1739 1739
    D8999.6 Herbst Appl Lab Cost 0 360 496 538 255 255 255
    D8999.7 Presurgical Ortho DX 0 0 0 0 0 0 0
    D8999.8 Spring Aligner 235 235 322 322 213 213 213
    D8999.9 Ortho TADS (mini-implant screws) 0 156 0 0 0 0 0
    D8999.B Rebanding 223 223 215 99999 99999 99999 99999
    D9110 Palliative Tx of dental pain 86 106 129 150 68 68 68
    D9120 Sectioning of FPD 186 224 230 253 158 138 138
    D9210 Local anesthesia - w/o surg 0 0 0 0 36 0 0
    D9211 Regional block anesthesia 71 85 96 106 64 53 50
    D9212 Trigeminal division block anes 197 241 266 292 185 154 154
    D9215 Local anesthesia w/ surg proc 0 0 0 0 0 0 0
    D9219 Evaluation for deep sedation or general anesthe 94 94 94 104 342 343 343
    D9223 Deep sedation/general anesthesia – each 15 mi 172 172 209 236 172 172 172
    D9230 Analg, anxiolysis, inhal of NO 72 72 80 86 71 72 72
    D9241.1 Interv sedate/analg - sedation experience 99999 0 99999 99999 50000 99999 99999
    D9241.2 Interv sedate/analg - sedation assist 0 0 0 0 0 0 0
    D9241.3 IV -Sedation Appt canceled 99999 0 99999 99999 50000 99999 99999
    D9243 Intravenous mod (conscious) sedation/analgesi 100 100 200 236 172 172 172
    D9248 Non-intrav conscious sedation 231 231 231 235 216 226 226
    D9248.1 Non-interv conscious sedation - sedation experi 99999 0 99999 99999 50000 99999 99999
    D9248.2 Non-interv conscious sedation - sedation assist 99999 0 99999 99999 50000 99999 99999
    D9248.3 Non IV -Sedation Appt canceled 99999 0 99999 99999 50000 99999 99999
    D9310 Consultation 84 105 136 150 64 64 64
    D9410 House/ext. care facility call 151 183 235 259 123 124 124
    D9420 Hospital call 0 0 0 0 148 0 0
    D9430 Office visit -observation only 50 64 81 89 47 41 40
    D9430.1 Endo-Off Visit 0 0 0 0 0 0 0
    D9430.2 Ortho-Off Visit 0 0 0 0 0 0 0
    D9430.3 Oral Surg-Off Visit 0 0 0 0 0 0 0
    D9430.4 Perio-Off Visit 0 0 0 0 0 0 0
    D9430.5 Pedo-Off Visit 0 0 0 0 0 0 0
    D9430.6 Prosth-Off Visit 0 0 0 0 0 0 0
    D9430.7 Oper/Fixed-Off Visit 0 0 0 0 0 0 0
    D9440 Office visit - after hours 118 146 179 201 90 90 90
    D9450 Case presentation, Detailed & 0 77 149 165 0 0 0
    D9450.1 Endo, Case Presentation 0 0 0 0 0 0 0
    D9450.2 Periodontal Treatment Plan Presentation 0 0 0 0 0 0 0
    D9450.3 Fixed, Case Presentation 0 0 0 0 0 0 0
    D9450.4 Removable, Case Presentation 0 0 0 0 0 0 0
    D9450.5 Ortho Consult, Case Presentati 0 0 0 0 0 0 0
    D9450.6 TPU Transfer Patient Update 0 0 0 0 0 0 0
    D9450.7 TPW Treatment Plan Workup 0 0 0 0 0 0 0
    D9450.8 Geriatric, Tx Planning 0 0 0 0 0 0 0
    D9450.9 Implant, Case Presentation 0 0 0 0 0 0 0
    D9610 Therap.drug inject, single adm 71 85 107 119 53 69 53
    D9612 Therp.drug inj, 2 or more admn 116 144 175 178 117 89 89
    D9630 Other drugs/medicaments 29 33 33 37 29 25 25
    D9910 Applicate desensitizing medica 42 50 63 69 32 46 34
    D9911 Applicate desens resin-per tth 53 68 80 90 51 46 42
    D9920 Behavior management 89 110 135 137 87 72 72
    D9930 Tx,complications-unusual circs 100 121 139 153 93 77 77
    D9932 Cleaning/inspection removable complete dentu 49 49 54 62 34 34 34
    D9933 Cleaning/inspection removable complete dentu 49 49 54 62 34 34 34
    D9934 Cleaning/inspection removable partial denture, 49 49 54 62 34 34 34
    D9935 Cleaning/inspection removable partial denture, 49 49 54 62 34 34 34
    D9940 Occlusal guard 426 522 622 685 314 318 316
    D9941 Fabrication of athl mouthguard 167 205 252 288 124 124 124
    D9941.1 Mold for Athletic Mouthguards 41 41 41 41 41 41 41
    D9942 Repair/reline Occl Guard 166 203 252 284 161 125 122
    D9943 Occlusal guard adjustment 152 190 233 364 141 119 119
    D9950 Occlusion analysis-mountd case 237 288 357 363 223 176 176
    D9951 Occlusal adjustment - limited 121 150 194 213 90 91 90
    D9952 Occlusal adjustment - complete 484 590 721 793 358 358 358
    D9970 Enamel microabrasion 150 182 214 230 140 111 111
    D9971 Odontoplasty 1-2 teeth 118 146 180 198 112 86 86
    D9972 In-office External bleaching - per arch 219 269 314 345 201 163 162
    D9972.1 In-office One Hour Bleaching per arch 338 442 544 555 305 268 268
    D9973 In-office External bleaching - per tooth 170 209 230 253 152 125 125
    D9974 Internal bleaching - per tooth 201 247 301 331 192 150 150
    D9975 At home External bleaching per arch 219 262 262 288 201 163 162
    D9986 Missed appointment 37 0 47 52 0 0 0
    D9987 Cancelled appointment 0 0 0 0 0 0 0
    D9999 Unspecified adjunctive proc. 63 72 94 104 49 49 49
    D9999.1 No Charge Office Visit 0 0 0 0 0 0 0
    DCMP10 Soft Tissue Exam Competency 0 0 0 0 0 0 0
    E0486 Oral Device/Appliance Custom Fab 1900 99999 2950 2950 99999 99999 99999
    E0486.1 Oral Device/Appliance - TAP 0 0 0 0 99999 99999 99999
    E0486.2 Oral Device/ Appl Custom Fab-AGD 1305 0 0 0 99999 99999 99999
    E0486.3 Oral Device/Appliance Custom Fab - Faculty 0 0 0 0 99999 99999 99999
    E1001 Gold 0 0 0 0 99999 99999 99999
    E1002 Amalgam 0 0 0 0 99999 99999 99999
    E1003 Composite 0 0 0 0 99999 99999 99999
    E1004 Miscellaneous Metallic 0 0 0 0 99999 99999 99999
    E1005 Porcelain 0 0 0 0 99999 99999 99999
    E1006 Sedative 0 0 0 0 99999 99999 99999
    M10180 Wound I & D 448 448 597 657 99999 99999 99999
    M11000 Debridement Eczematous or Infe 0 0 0 0 99999 99999 99999
    M11012 Debridement-skin,subcutaneous 0 0 0 0 99999 99999 99999
    M11100 Biopsy of skin,subcutaneous ti 131 131 174 191 99999 99999 99999
    M11900 Intralesional lesion<> 67 67 71 75 99999 99999 99999
    M11901 Intralesional>> 0 0 0 0 99999 99999 99999
    M12001 Simple repair of superficial w 98 98 104 108 99999 99999 99999
    M12002 Simple repair;2.6 cm to 7.5 cm 98 98 104 108 99999 99999 99999
    M12004 Simple repair;7.6 to 12.5 cm 0 0 0 0 99999 99999 99999
    M12005 Simple repair;12.6 to 20.0 cm 0 0 0 0 99999 99999 99999
    M12011 Simple repair;2.5 cm or less 308 308 411 451 99999 99999 99999
    M12013 Simple repair;2.6 to 5.0 cm 330 330 442 485 99999 99999 99999
    M12014 Simple repair;5.1 to 7.5 cm 398 398 531 584 99999 99999 99999
    M12015 Simple repair;7.6 to 12.5 cm 498 498 664 731 99999 99999 99999
    M12017 Simple Repair Wounds:20.1 CM 738 738 984 1082 99999 99999 99999
    M12018 Simple repair;over 30.0 cm 810 810 1081 1189 99999 99999 99999
    M12020 Simple repair;over 30.0 cm 374 374 499 549 99999 99999 99999
    M12031 Layer Closure;2.5 cm or less 0 0 0 0 99999 99999 99999
    M12034 Layer Closure of Wounds:7.6CM 0 0 0 0 99999 99999 99999
    M12051 Layer Closure;2.5 cm or less 365 365 487 535 99999 99999 99999
    M12052 Layer Closure;2.6 to 5.0 cm 407 407 542 597 99999 99999 99999
    M12053 Layer Closure;5.1 to 7.5 cm 496 496 661 727 99999 99999 99999
    M12054 Layer Closure;7.6 to 12.5 cm 615 615 820 903 99999 99999 99999
    M12055 Layer Closure;12.6 to 20.0 cm 778 778 1039 1142 99999 99999 99999
    M13120 Repair,comp.,scalp;1.1to 2.5 0 0 0 0 99999 99999 99999
    M13121 Repair,comp.,scalp,2.6to7.5 608 608 810 891 99999 99999 99999
    M13122 Repair,comp.,scalp,add 5/les 255 255 340 374 99999 99999 99999
    M13131 Repair,comp.,mouth,1.1to2.5 481 481 642 705 99999 99999 99999
    M13132 Repair,comp.,mouth, 2.6to7.5 c 790 790 1055 1160 99999 99999 99999
    M13133 Repair,comp.,mouth, add 5/less 342 342 456 501 99999 99999 99999
    M13150 Repair,comp.,lips, 1.0/less 533 533 711 782 99999 99999 99999
    M13151 Repair,comp.,lips,1.1to2.5 cm 621 621 828 911 99999 99999 99999
    M13152 Repair,comp.,lips,2.6to7.5 cm 1062 1062 1417 1559 99999 99999 99999
    M13153 Repair,comp.,lips,add 5/less 360 360 480 529 99999 99999 99999
    M15240 Full thick graft,20 sq cm/less 1554 1554 2072 2279 99999 99999 99999
    M15820 Blepharoplasty,Lower Eyelid 0 0 0 0 99999 99999 99999
    M17000 Destruction lesion,first lesio 95 95 126 139 99999 99999 99999
    M20000 Musculoskeletal System (incisi 0 0 0 0 99999 99999 99999
    M20220 Biopsy; superficial 368 368 492 540 99999 99999 99999
    M20240 Biopsy,bone 570 570 761 836 99999 99999 99999
    M20550 Trigger Point Injection 120 120 160 176 99999 99999 99999
    M20605 Arthrocentesis aspiration 122 122 165 180 99999 99999 99999
    M20680 Removal of implant,deep 954 954 1272 1401 99999 99999 99999
    M20900 Bone graft,any,minor,small 977 977 1303 1433 99999 99999 99999
    M20926 Tissue grafts,other 939 939 1253 1377 99999 99999 99999
    M20999 Unlisted Procedure, musculoske 99999 99999 511 520 99999 99999 99999
    M21010 Arthrotomy,temporomandibular j 2318 2318 3090 3400 99999 99999 99999
    M21015 Radical tumor resect.,soft,fac 1346 1346 1796 1974 99999 99999 99999
    M21025 Excision of bone,mandible 1582 1582 2108 2320 99999 99999 99999
    M21030 Excision of Benign Tumor 1223 1223 1630 1793 99999 99999 99999
    M21031 Excision of torus mandibularis 595 595 793 872 99999 99999 99999
    M21040 Exc. benign cyst/tumor,mandibl 1036 1036 1382 1520 99999 99999 99999
    M21041 Exc. benign cy/tu,mand., compl 0 0 0 0 99999 99999 99999
    M21050 Arthrectomy, TMJ; unilateral 2703 2703 3602 3963 99999 99999 99999
    M21070 Coronoidectomy;separate proc 2160 2160 2878 3166 99999 99999 99999
    M21079 Impression & Custom Prep;Inter 3730 3730 4972 5469 99999 99999 99999
    M21080 Definitive Obtruator Pros. 4060 4060 5414 5955 99999 99999 99999
    M21085 Impres/cust prep; o.s. splint 1212 1212 1616 1778 99999 99999 99999
    M21088 Impres&Cust Prep:Facial Pros 1542 1752 2334 2569 50000 99999 99999
    M21089 Unlisted Maxillofacial Prosthe 99999 99999 99999 99999 99999 99999 99999
    M21110 Interdental fixation device 1198 1198 1598 1759 99999 99999 99999
    M21120 Genioplasty,Augmentation 1603 1603 2137 2351 99999 99999 99999
    M21125 Augmentation,mand. body;prosth 2545 2545 3394 3733 99999 99999 99999
    M21139 Countoring & setback ant. Sinu 3084 3084 4111 4523 99999 99999 99999
    M21141 Reconstruct. midface, lefort I 4483 4483 5979 6576 99999 99999 99999
    M21142 Reconstruct. midface,lefort I 4679 4679 6238 6862 99999 99999 99999
    M21143 Reconstruc midface,lefort I 4820 4820 6427 7069 99999 99999 99999
    M21146 Reconstruct midface,lefort I 4885 4885 6513 7165 99999 99999 99999
    M21147 Reconstruct Midface Lefort 1 5587 5587 7451 8195 99999 99999 99999
    M21188 Reconstruct Midface Osteotomie 5046 5046 6729 7402 99999 99999 99999
    M21193 Reconstruct of MandibularRamus 4131 4131 5508 6058 99999 99999 99999
    M21195 Reconstruct mand ramus,sagitt 4502 4502 6003 6603 99999 99999 99999
    M21196 Reconstruct mand. ramus sagitt 4675 4675 6233 6856 99999 99999 99999
    M21209 Osteoplasty,facial bones,reduc 1779 1779 2372 2610 99999 99999 99999
    M21210 Graft,Bone:Nasal,Maxillary & 3122 3122 4163 4579 99999 99999 99999
    M21215 Graft, bone, mandible 3258 3258 4344 4779 99999 99999 99999
    M21235 Graft,Ear Cartilage,Autograft, 0 0 0 0 99999 99999 99999
    M21240 Arthroplasty, TMJ; autograft 3937 3937 5248 5773 99999 99999 99999
    M21248 Reconstruct mx/md,endosteal im 3339 3339 4454 4898 99999 99999 99999
    M21249 Reconstruct mx/md,endosteal im 4882 4882 6509 7160 99999 99999 99999
    M21299 Unlisted craniofacial procedur 99999 99999 99999 99999 99999 99999 99999
    M21315 Manipulative tx, nasal bone fr 448 448 597 657 99999 99999 99999
    M21320 Manipulative tx, nasal bone fr 716 716 955 1052 99999 99999 99999
    M21325 Open Treatment of Nasal Fractu 1156 1156 1542 1695 99999 99999 99999
    M21336 Open tx, nasal fx, stabilizati 1420 1420 1894 2083 99999 99999 99999
    M21338 Open tx, nasoethmoid fracture 1921 1921 2561 2817 99999 99999 99999
    M21339 Open tx, nasoethmoid fracture 2238 2238 2983 3281 99999 99999 99999
    M21344 Open tx, comp. front sinus fra 3693 3693 4924 5416 99999 99999 99999
    M21346 Open Treatment Nasomaxillary 3090 3090 4122 4534 99999 99999 99999
    M21356 Open tx, depressed zygomatic a 1358 1358 1810 1993 99999 99999 99999
    M21360 Open tx,closed/open malar frac 1709 1709 2279 2506 99999 99999 99999
    M21365 Open tx,closed/open comp malar 3170 3170 4228 4650 99999 99999 99999
    M21366 Open tx, comp frac malar,bone 3391 3391 4521 4973 99999 99999 99999
    M21386 Open tx, orbital floor blowout 2365 2365 3155 3471 99999 99999 99999
    M21390 Open tx, orbital blowout fract 2948 2948 3931 4323 99999 99999 99999
    M21406 Open tx, fracture orbit w/o bl 2142 2142 2857 3142 99999 99999 99999
    M21421 Palatal or Alveolar Ridge Frac 1851 1851 2468 2715 99999 99999 99999
    M21422 Open tx, palatal/alveo ridge f 2254 2254 3005 3306 99999 99999 99999
    M21423 Open tx, palatal mx fracture 2585 2585 3447 3793 99999 99999 99999
    M21433 Open tx, craniofacial separati 4553 4553 6071 6678 99999 99999 99999
    M21435 Complicated, fixation by head 4144 4144 5525 6079 99999 99999 99999
    M21440 Manipulative tx alveolar ridge 1227 1227 1635 1800 99999 99999 99999
    M21451 Closed/open md fracture 1648 1648 2199 2419 99999 99999 99999
    M21453 Open Mandibular Fracture/Manip 1827 1827 2434 2678 99999 99999 99999
    M21454 Open tx closed/open md fractur 2112 2112 2817 3098 99999 99999 99999
    M21461 Open tx, closed/open md fractu 2896 2896 3862 4248 99999 99999 99999
    M21462 Open tx, closed/open md frac 3162 3162 4217 4638 99999 99999 99999
    M21470 Open tx, comp closed/open md 3927 3927 5236 5759 99999 99999 99999
    M21480 Uncomplicated treatment of TMJ 228 228 304 335 99999 99999 99999
    M21499 Unlisted musculoskeletal proce 99999 99999 477 516 99999 99999 99999
    M21555 Excision benign tumor;subcutan 0 0 0 0 99999 99999 99999
    M29804 Arthroscopy TMJ; surgical 2333 2333 3112 3422 99999 99999 99999
    M30000 Respiratory System (drainag 0 0 0 0 99999 99999 99999
    M30580 Repair fistula;oromaxillary 1392 1392 1855 2041 99999 99999 99999
    M31020 Sinusotomy,mx,intranasal 674 674 899 988 99999 99999 99999
    M31030 Sinusotomy mx,intranasal radic 1564 1564 2086 2294 99999 99999 99999
    M40000 Digestive System 0 0 0 0 99999 99999 99999
    M40490 Biopsy of lip 173 173 231 254 99999 99999 99999
    M40510 Excision Lip/closure 1219 1219 1625 1787 99999 99999 99999
    M40800 Drainage of abscess,cyst,hemat 267 267 355 391 99999 99999 99999
    M40801 Drainage Abscess,Cyst,Hematoma 520 520 693 763 99999 99999 99999
    M40804 Removal of embedded foreign bo 292 292 391 429 99999 99999 99999
    M40808 Biopsy,vestibule of mouth 271 271 362 398 99999 99999 99999
    M40810 Excision of lesion of mucosa/s 300 300 400 441 99999 99999 99999
    M40812 Excision, vestibule closure 394 394 525 578 99999 99999 99999
    M40814 Excision lesion of mucosa/subm 674 674 899 988 99999 99999 99999
    M40816 Complex exc. Of muscle 787 787 1050 1155 99999 99999 99999
    M40818 Exc.mucosa,vest.donor 537 537 716 788 99999 99999 99999
    M40819 Exc. Frenum,lab.or buc. 442 442 589 648 99999 99999 99999
    M40820 Destruction of lesion or scar 351 351 467 515 99999 99999 99999
    M40830 Closure of laceration,vestibul 342 342 456 501 99999 99999 99999
    M40831 Closure laceration,vestibule m 473 473 631 695 99999 99999 99999
    M41000 Intraoral incision/drainage to 248 248 329 363 99999 99999 99999
    M41005 Intraoral incision/drainage to 302 302 403 444 99999 99999 99999
    M41007 Intraoral incision/drainage to 591 591 789 869 99999 99999 99999
    M41008 Intraoral incision/drainage to 588 588 784 863 99999 99999 99999
    M41009 Intraoral incision/drainage to 687 687 914 1007 99999 99999 99999
    M41016 Extraoral Incision & Drainage 677 677 902 991 99999 99999 99999
    M41017 Extraoral incision/drainage fl 716 716 955 1052 99999 99999 99999
    M41100 Biopsy tongue;anterior 2/3 283 283 376 414 99999 99999 99999
    M41105 Biopsy tongue;post 1/3 291 291 390 428 99999 99999 99999
    M41108 Biopsy floor of mouth 244 244 324 357 99999 99999 99999
    M41110 Excision of Lession of Tougue 328 328 438 482 99999 99999 99999
    M41112 Excision,ant 2/3 closoure 556 556 741 816 99999 99999 99999
    M41113 Excision, post. 1/3 closure 671 671 894 983 99999 99999 99999
    M41116 Excision, Lesion flloor Mouth 611 611 816 898 99999 99999 99999
    M41250 Repair laceration 2.5 cm/less 366 366 490 538 99999 99999 99999
    M41252 Repair Laceration Tongue,Floor 699 699 932 1024 99999 99999 99999
    M41520 Frenuloplasty 585 585 781 858 99999 99999 99999
    M41805 Remov of Foreign body, soft ti 287 287 384 422 99999 99999 99999
    M41806 Remov of Foreign body, bone 397 397 529 582 99999 99999 99999
    M41820 Gingivectomy,excision gingiva 502 502 669 737 99999 99999 99999
    M41821 Operculectomy,exc.pericoronal 124 124 166 181 99999 99999 99999
    M41822 Excision of fibrous tuberositi 350 350 465 513 99999 99999 99999
    M41823 Excision of osseous tuberositi 620 620 826 909 99999 99999 99999
    M41825 Excision, alveolus closure 342 342 456 501 99999 99999 99999
    M41826 Excision, alveolus closure 497 497 663 730 99999 99999 99999
    M41828 Excision hyperplastic alveo mu 600 600 798 878 99999 99999 99999
    M41830 Alveol.Incl Curr. Of Osteitis 567 567 755 831 99999 99999 99999
    M41850 Destruction of lesion,dentoalv 247 247 328 362 99999 99999 99999
    M41870 Periodontal mucosal grafting 617 617 822 905 99999 99999 99999
    M41872 Gingivoplasty,each quadrant 693 693 923 1016 99999 99999 99999
    M41874 Alveoplasty 630 630 841 925 99999 99999 99999
    M41899 Unspecified proc., dentoalveol 99999 99999 99999 99999 99999 99999 99999
    M42000 Drain abscess of palate 293 293 392 431 99999 99999 99999
    M42100 Biopsy of palate, uvula 277 277 368 406 99999 99999 99999
    M42104 Excision, palate 378 378 504 556 99999 99999 99999
    M42106 Excision, palate closure 476 476 633 697 99999 99999 99999
    M42107 Excision lesion platale w/loca 1041 1041 1387 1526 99999 99999 99999
    M42160 Destruction of lesion, palate 399 399 533 585 99999 99999 99999
    M42180 Repair laceration palate up to 424 424 566 622 99999 99999 99999
    M42210 Palatoplasty cleft palate w/bo 3438 3438 4582 5041 99999 99999 99999
    M42310 Drain of absc.sub max or subli 311 311 413 455 99999 99999 99999
    M42325 Fistulization of subling. Sali 0 0 0 0 99999 99999 99999
    M42330 Sumbandibular,sublingual or 413 413 550 606 99999 99999 99999
    M42720 Incision/drain abs;intraoral 731 731 974 1071 99999 99999 99999
    M60000 Thyroglossal I & D 0 0 0 0 99999 99999 99999
    M64400 Trigeminal Anesthesia 258 258 345 379 99999 99999 99999
    M64550 Application of surface neurost 46 46 64 69 99999 99999 99999
    M64722 Decompression;unspec. nerve 0 0 0 0 99999 99999 99999
    M65000 Eye and Ocular Adnexa 0 0 0 0 99999 99999 99999
    M67914 Repair of Extropion;suture 0 0 0 0 99999 99999 99999
    M70000 Diagnostic Radiology 0 0 0 0 99999 99999 99999
    M70100 Panogram, mandible 25 25 32 35 99999 99999 99999
    M70140 Radiograph, facial bones 98 98 104 112 99999 99999 99999
    M70250 Skull, less than 4 views 33 33 43 47 99999 99999 99999
    M70300 Radiologic exam, teeth;single view 12 12 16 16 99999 99999 99999
    M70310 Radiologic exam;teeth,partial 12 12 13 15 99999 99999 99999
    M70320 Radiologic exam, complete, full mouth 100 100 100 100 99999 99999 99999
    M70328 Radio,Exam,TMJ, open&clsd unil 26 26 33 36 99999 99999 99999
    M70330 Radio.,Exam,TMJ,open&clsd bila 33 33 43 47 99999 99999 99999
    M70350 Cephalogram,Orthodontic 99 99 99 99 99999 99999 99999
    M70355 Orthopantogram (Panoramic) 84 84 0 84 99999 99999 99999
    M70380 Radiology Exam. Salivary 23 23 30 33 99999 99999 99999
    M76100 Radiological exam, single plan 159 159 212 233 99999 99999 99999
    M76101 Cross-sec. Oblique tomogram, i 235 235 314 343 99999 99999 99999
    M76140 Radiology Consult 65 65 84 94 99999 99999 99999
    M76175 Duplicate Films 0 0 28 28 99999 99999 99999
    M76449 Duplication/records 0 0 69 69 99999 99999 99999
    M76999 Unlisted Ultrasound Procedure 0 0 0 0 99999 99999 99999
    M78300 Bone and/or joint imaging 0 0 0 0 99999 99999 99999
    M80000 Pathologic Examination 0 0 0 0 99999 99999 99999
    M87070 Culture, bacterial, any other 49 49 68 74 99999 99999 99999
    M87205 SMEAR,PRIMARY SOURCE W/INT. 24 24 31 34 99999 99999 99999
    M87210 Culture,bacterial screening on 67 67 136 210 99999 99999 99999
    M88304 Surgical Path, Gross & Microsc 94 94 125 138 99999 99999 99999
    M88305 Surgical Path., Gross & Micros 161 161 215 237 99999 99999 99999
    M88311 Decalcification Procedure 33 33 43 47 99999 99999 99999
    M90000 Evaluation and Management 0 0 0 0 99999 99999 99999
    M90782 IV sympathetic Blockade 0 0 0 0 99999 99999 99999
    M90784 Therapeutic/Diagnostic Injecti 98 98 104 219 99999 99999 99999
    M90792 Therapeutic/Diagnostic Injecti 0 0 0 0 99999 99999 99999
    M90830 Review of Records 55 55 66 67 99999 99999 99999
    M90901 Biofeedback 50 50 69 75 99999 99999 99999
    M91480 Manipulation 0 0 105 106 99999 99999 99999
    M94762 Noninvasive Pulse Oximetry (Overnight monitor 57 57 57 57 99999 99999 99999
    M95868 Electromyography,bilateral 0 0 0 0 99999 99999 99999
    M95999 Unspecified neurological 99999 99999 99999 99999 99999 99999 99999
    M96405 Intralesional Chemotherapy 98 98 0 0 99999 99999 99999
    M97026 Infrared 0 0 39 39 99999 99999 99999
    M97032 Application Of Modality To One 35 35 46 50 99999 99999 99999
    M97110 Physical medicine treatment 62 62 81 90 99999 99999 99999
    M97139 Unlisted procedure 99999 99999 99999 99999 99999 99999 99999
    M97140 Manual Therapy 0 0 55 55 99999 99999 99999
    M97260 Refrigerant Spray/Stretch 0 0 34 43 99999 99999 99999
    M97265 Joint Mobilization 0 0 69 69 99999 99999 99999
    M97540 Train/Daily Living 0 0 104 104 99999 99999 99999
    M97780 Acupuncture 0 0 97 97 99999 99999 99999
    M97781 Acupuncture (E.S.) 0 0 122 122 99999 99999 99999
    M97799 Unlisted Procedure 99999 99999 49 49 99999 99999 99999
    M97810 Initial Acupuncture Therapy (W/O) stim 0 0 55 55 99999 99999 99999
    M97811 Acupuncture Therapy Addl 15 mins (W/O stim) 0 0 29 29 99999 99999 99999
    M97813 Initial Acupuncture Therapy (W stim) 0 0 72 72 99999 99999 99999
    M97814 Acupuncture Therapy Addl 15 mins (W/stim) 0 0 33 33 99999 99999 99999
    M99002 Adjustment 27 27 34 38 99999 99999 99999
    M99024 OV-Post OP 45 45 69 89 99999 99999 99999
    M99050 OV-after hrs-basic service 58 58 77 84 99999 99999 99999
    M99058 Office Emerg. Basis 50 50 69 75 34 34 34
    M99070 Supplies & Materials, Provided 99999 99999 99999 99999 0 0 0
    M99201 Office or outpatient visit 69 69 92 100 45 45 45
    M99202 Office or outpatient visit 95 95 126 139 64 64 64
    M99203 Office or outpatient visit 145 145 193 213 97 97 97
    M99204 Office or outpatient visit 213 213 285 314 142 142 142
    M99205 Office or outpatient visit 278 278 370 407 185 185 185
    M99211 Exam, Est. Pt. Brief 37 37 48 53 25 25 25
    M99212 Office or other outpatient visit 58 58 101 101 39 39 39
    M99213 Office or outpatient visit 84 84 114 125 57 57 57
    M99214 Exam, Est. Pt. Ext. 129 129 171 188 84 84 84
    M99215 Office or other ouptatient vis 179 179 240 262 119 119 119
    M99217 Observation care discharge 0 0 0 0 99999 99999 99999
    M99218 Initial observation care 124 124 166 181 99999 99999 99999
    M99221 Initial hospital care 153 153 205 224 99999 99999 99999
    M99231 Subsequent hospital care 73 73 97 107 99999 99999 99999
    M99232 Subsequent hospital care 107 107 142 156 99999 99999 99999
    M99241 Office consultation 94 94 124 136 99999 99999 99999
    M99242 Office consultation 152 152 203 222 99999 99999 99999
    M99243 Office consultation 197 197 262 289 99999 99999 99999
    M99244 Comprehensive history consult 279 279 371 408 99999 99999 99999
    M99251 Initial inpatient consultation 113 113 150 166 99999 99999 99999
    M99252 Initial inpatient consultation 180 180 242 265 99999 99999 99999
    M99253 Initial inpatient consultation 228 228 304 335 99999 99999 99999
    M99254 Initial inpatient consultation 280 280 372 409 99999 99999 99999
    M99262 Consult, FollowUP In Pt. 0 0 0 0 99999 99999 99999
    M99271 Confirming Cons. P. O. 0 0 0 0 99999 99999 99999
    M99302 Eval./manage;nursing facility 0 0 0 0 99999 99999 99999
    M99401 Preventive Counseling 65 65 84 94 99999 99999 99999
    M99402 Preventive Counseling Expaned 100 100 133 147 99999 99999 99999

    Formulary and Best Practices Review Committee Forms Policy

    Subject: Class III – Clinical – H. Patient Administration

    Effective Date: 03/01/2023

    Policy and/or Procedure:

    This policy is to review clinic devices and materials. The request forms for the purchase of new and different items to replace current items are linked within this policy.

    A faculty member would introduce the material, speak with the Program Director, and then their Department Chair would approve or disapprove. If approving, there must be justification for using this new material with an explanation as to why this material is superior to the materials currently being used. A cost analysis needs to be performed and noted on the form. The appropriate form is to be sent to the appropriate persons (see below) for approval. If approved, the Associate Dean of Clinical Affairs would notify the Director of CMS and/or School Store Manager. 

    Faculty training of the product/device submitted for approval must be done to show how the product will be implemented. The new materials and new products should be discussed at the Department meetings. These meetings need to have minutes.    

    If the product is a replacement, one of the requirements is to use the current item first. Faculty inform CMS/School Store who are responsible for checking inventory to assure the current item is used before ordering the new item. 

    The necessary forms are as follows: 

    1. Formulary and Best Practices Review Committee Submission Form (DOC): This form is to show that we are using a new material for educational purposes. This form is to satisfy Standard 5.2. The instructions for completing the form are as follows:  
      1. This is the first form that has to be completed by the Faculty member, which is used to request using a new product or device. 
        1. There must be justification for using this new material with an explanation as to why this material is superior to the materials being used. 
        2. A Cost Analysis must be included.  
        3. The Form and back up documentation is reviewed/approved by the Faculty provider’s Department Chair. If approved, it is sent to the Associate Dean of Clinical Affairs for review/approval.  
        4. The Associate Dean of Clinical Affairs reviews to ensure it is clinically relevant and for any gift component or IT component. (NOTE: If replacing a current item, the inventory supply would be checked by the School Store Manager.) 
        5. If approved and the product has:
          1. No gift component or IT component then the form, cost analysis and back up information would go before the Formulary Committee for review and approval.  
        6. If approved, the form is stamped, approved, dated, and logged.
          1. If a gift component, then the form is sent to the Assistant Dean of Development to review/approve.
          2. If an IT component is present, the form is sent to the Executive Director of IT to review/approve.
          3. The form is then sent back to the Associate Dean of Clinical Affairs for Committee review/approval.

        Note: If the product/device is a non-gift item (for example: a new printer, demo machine, or software), the Executive Director of IT and Associate Dean of Clinical Affairs need to know the faculty/staff making the request, the name of the vendor, and the purpose of the product/device.  This applies to anything that has to be integrated into our IT system. This form is for products/devices we use in the clinics, (not on the research floors: 6th, 7th, 8th, and 9th floors). If the product/device has a specific purpose (printer, software, etc.), it is not a gift. If it is not a gift, it does not have to go through Assistant Dean of Development. 

    2. If the product is a clinical supply item, a Request for Clinic Supplies not Currently Available from the School Store Form (DOC) needs to be completed in addition to the Formulary and Best Practices Review Committee Submission Form and follow the process listed in item 1 above. 
    3. Formulary Form for Gifts Received: If  the item is a gift from a vendor, a Formulary and Best Practices Review Committee Submission Form (linked in item 1 above) needs to be filled out and follow the process noted above. Then, all gifts need to go to the 6th floor. 

    All gifts must:

    • First go to Assistant Dean of Development to be sure it is indeed a gift (with no conditions).
    • The requestor must log the meeting with the representative stating whom you met with and the company name. (Note: This is to ensure no conflict of interest. Even items such as a case of toothpaste need to be logged in with the Assistant Dean of Development.) 
    • Then, the request goes to the Executive Director for IT and HIPAA purposes. 
    • The last person who reviews the request is the Associate Dean of Clinical Affairs who ensures the request fits into the clinical program asking the following questions: 
      • Can we use it? 
      • What are the directions for use?
      • How is it sterilized or disinfected if for intra-oral use?
      • Has it been reported to CMS?

    Inactivation of Patient Account Procedure

    Subject: Class III – Clinical – H. Patient Administration

    Reviewed and/or Revised: 09/01/2017

    Policy and/or Procedure

    • Before inactivating a patient chart, the student must check axiUm to ensure that all fees have been paid.
    • Update the patient's status before the inactivation.
    • The reasons for inactivation must be recorded on the Progress Notes and signed by the student and G.P. Manager.
    • The completed inactivation letter and signed chart must be brought to the Patient Care Coordinator to process the inactivation.

    Pediatric patients

    • All inactivations must be recorded in the patient's record and signed by a Pediatric Dentistry instructor.
    • Students will then complete an inactivation letter and bring it to a Patient Care Coordinator.
    • The student should inform the Patient Care Coordinator if a replacement is needed.
    • Any special requests for patient assignments should be made with the Predoctoral Pediatric Dentistry Director.

    Informed Consent Policy and Procedure

    Subject: Class III – Clinical – H. Patient Administration

    Department: Office of Information Technology

    Origination Date: July 16, 2013

    Effective Date: July 16, 2013

    Reviewed and/or Revised: 09/01/2017

    Purpose: The purpose of this policy is to ensure that no treatment is administered to a patient without complete disclosure or without signed authorization by the patient or patient's guardian.

    Definitions: Axium – School of Dentistry’s electronic patient record system.

    Approval - Approval is needed for the tasks mentioned. Click the Approve button Approve to complete Approval. If the user has forgotten to approve an item, follow the directions below.

    1. The Teal Box on the footer indicates something needs approval. Click the box to see what needs approval. Needs Approval
    2. The user may approve all of the items listed or approve each individually. Click the first Line Item that needs approval.
    3. Click the Approve button. Approve
    4. Also look for the “EPR Forms” on the bottom. If this is still in Blue then something needs approval. EPR Forms

    Notice all text is in Black. Remember the Teal and Blue = Approval Needed.

    Policy and/or Procedure: Providers will obtain written informed consent from patients (or patient's guardian) prior to treatment. Initial informed consent is obtained during patient registration and subsequently during the presentation of a treatment plan and when the proposed treatment is modified or when additional treatment is proposed.

    In order to follow the procedures below, the user must log into Axium with their specific username and password, or swipe card.

    To Enter an Informed Consent

    1. Select a patient.
      1. To search for a patient, click the Rolodex module. Rolodex module
      2. Click in the blank field. Blank Field
      3. Type a Patient's Name (Last, First).
      4. To search for the patient, Press [Enter].
      5. Click the Item Line of your patient.
        Item Line of Patient
      6. At this point, you have selected your patient. To ensure you have selected your patient, check if the patient’s name and chart number are on the footer bar.
    2. Click the Electronic Health Record module. Electronic Health Record Module
    3. Click the Tx History tab. Tx History Tab-writing a progress Note
    4. Click the Add Patient Tx Consent button. Add Patient Tx Consent button
    5. Click the ... Box button. Box button
    6. There are multiple types of consents: Day of Treatment Consent, Prosth Delivery Consent, Refusal of Recommended Tx, Treatment Plan Consent, Termination of Tx Release. Double-click one of the consent Line Items.
    7. Click the OK button. OK
    8. Click all the Treatment Line Items the consent is needed for. Note: the treatment must be approved.
    9. Click the OK button. OK
    10. Additional comments may be added in the free text field.
    11. Click the OK button. OK
    12. Notice that the form is automatically pre-populated with information from previous forms. After reviewing with the patient, click the Close button.
    13. Depending on the type of consent executed, specific signatures are needed. The signatures needed include the patient, witness, and/or faculty. Signatures are gained through the signature pad connected to the PC. The required signatures window will automatically open. The user must gain the required signatures now.

    Interpretation Services

    LIONBRIDGE

    Language translation services are offered through Lionbridge for patients that request services. An interpreter can be scheduled in advance of an appointment for an in-person service as well as telephonic interpretations. In the case of unscheduled telephonic interpretation (UTI) arrangements can also be made by a school staff member.

    Click on the following link to learn more about Lionbridge Interpretation Services (PDF).

    THE HEARING AND SPEECH AGENCY (HASA)

    All patients that are in need of sign language interpretation for dental appointments will be scheduled with an interpreter. We will accommodate the patient or parent of a patient for all interpretation requests. Front desk staff and Patient Care Coordinators can contact HASA to make appointment arrangements.

    Click the following link to learn more about HASA's Centralized Interpreter Referral Service (CIRS). (PDF)

    Medical Assistance – Maryland Healthy Smiles Program

    Subject: Class III – Clinical – H. Patient Administration

    Effective Date: July 20 2009

    Reviewed and/or Revised: 09/01/2017

    Purpose

    To recognize that the Dental School participates with the Maryland Healthy Smiles Program and to provide an overview of the program to students, staff and faculty.

    Policy Statement

    The Dental School is a provider with the Maryland Healthy Smiles Program and as such accepts patients for treatment who are actively registered in the program. These patients may receive emergency or comprehensive dental care upon presentation of a valid Maryland Healthy Smiles Card.

    The eligible patient must present a valid Maryland Healthy Smiles card at each visit. At the time of registration the Maryland Healthy Smiles card number will be verified and recorded. If the patient presents a valid card during the course of treatment, it is the provider's responsibility to take the card to the reception staff or business manager for proper documentation in Axium.

    The eligible patient is entitled to necessary dental care, excluding fixed prosthodontics, and cast gold procedure, as indicated in the treatment plan. Pit an fissure sealants are covered only for the occlusal surface of posterior permanent teeth that are without restorations or decay. Gold restorations, gold crowns, gold replacement appliances, and bridges are not covered service. Orthodontic service is considered on a case by case basis.

    Preauthorization is required for the following procedures:

    1. Removable prosthodontics
    2. Single crowns
    3. Rebasing full or partial dentures
    4. Periodontal therapy
    5. Athletic Mouth Guard, and
    6. Orthodontics

    Request for preauthorization are completed prior to initialing treatment. Treatment may not be started on the above procedures until the approval has been received and notifications sent to the provider. Requests for orthodontics begin with the request to take ortho records.

    This authorization must be received before any treatment is initiated.

    Failures to comply with the above will delay treatment for your patients, since approvals may take up to six weeks. Performance of unauthorized care may result in withholding credit. Preauthorization requests are completed with the Insurance account clerk, Room GN317. Orthodontic preauthorizations are completed with the Business Manager, in the Clinic Operations Board Suite 5201.

    Other Third Party Payers – Dental Grant Programs Policy

    Subject: Class III – Clinical – H. Patient Administration

    Effective Date: July 20 2009

    Reviewed and/or Revised: 09/01/2017

    Purpose

    To ensure that patients with other third party payers are given the proper and appropriate care at the time of their visit. Also that the formal estimate for dental care must be sent to the sponsoring agency. Also all billing information must be sent within one fiscal year.

    Policy Statement

    From time to time patents are referred to the Dental School for care by outside agencies who are willing to accept the financial responsibility for their care. The initial contact is usually made by agency, social worker, or patient. A confirming letter or purchase order is received prior to the initial examination of the patient. This authorizes finds for the exam and treatment plan workup. The patient is not liable for fees at that time.

    After assignment, a plan of treatment should be formulated with a formal estimate form the Business Office presented to the sponsoring agency. All therapy should cease until a confirming purchase order of letter of authorization is received designating to what extent the patient is being financially supported. The Business Office on a timely basis will bill the agency for service rendered. Most agencies request only one billing at the end of treatment. It is important that treatment is completed in one fiscal year as these purchase orders are only valid for that time and any service not completed must be preauthorized via the preceding process. Changes in treatment must be reported and approval received before additional services are delivered. Agencies will only pay for what is listing on the confirming order form.

    Agencies of record at this time include: Vocational Rehabilitation, Walter P. Carter Center, Crippled Children's Association ,Jewish Family Services, American Kidney Fund, Jill Fox Fund, Ryan White Fund, Helping Up Mission and Organ Transplant Fund.

    Patient Administration Policy – Dental Hygiene

    Subject: Class III – Clinical – H. Patient Administration

    Department: Endodontics, Prosthodontics, Periodontics: Dental Hygiene Program

    Subject: Patient Administration

    Origination Date: 7/18/13

    Effective Date: 7/18/13

    Reviewed and/or Revised: 09/01/2017

    Purpose: To expedite treatment and ensure timeliness of care.

    Policy and/or Procedure:

    Patient recruitment

    Dental hygiene students may recruit their own patients to receive dental hygiene-only services. All ‘hygiene only’ patients must have a dental home (primary care provider) who oversees care of the patient. Hygiene students must ensure that a G.P. Director examines and informs each patient about the limited nature of the treatment for patients in this category. Patients may later be assigned to a dental student for comprehensive care. Dental Students may recruit and screen their own patients and provide comprehensive care. If the ‘hygiene only’ patient does not have a dental home, s/he must first go through the dental school screening process prior to receiving dental hygiene services.

    Transfer

    Patients for comprehensive care may be transferred from one assigned student to another.

    • Dental Hygiene students may transfer patients to another dental hygiene or dental student.
    • The G.P. Director or the Dental Hygiene Faculty must approve transfers.
    • Director of Special Patient Clinic must approve special Patient Clinic transfers in the chart.
    • The individual advanced specialty education clinic will contact the patient about procedures for acceptance.
    • A patient may be referred to another student for a limited treatment.
    • The original student remains primarily responsible for the patient even though both students may now treat the patient concurrently. The second student should render only those services indicated in the referral entry.

    Inactivation

    Patient record archiving

    • When an adult patient has not returned to the School of Dentistry for a period of 18-months, the record will be purged from the System and forwarded to the State of Maryland Archives.
    • For a minor, the record will be retained in the system until the minor reaches age twenty-one or for two years after the last appointment, at which time the parent or legal guardian is notified of our intent to forward the record to the Archives and is given thirty days to advise us that he/she wishes for us to retain the record in the System until the minor reaches age twenty-one. After five years, records at the Archives are destroyed
    • Inactive records that exceed retention limits are purged on a biannual basis and are given an “archived” status in the AxiUm systems.
    • Archived records are sent to State of Maryland record storage facility in Jessup, where they are retained for a period of five years, after which time, they are destroyed.

    Radiographs taken outside the School of Dentistry require patient consent before they can be requested from the practitioner (patient consent should be noted in the chart). Patient consent form can be obtained from the Chart Room Supervisor.

    Patient Appointment Policy

    Subject: Clinical III. – H. Patient Administration

    Department: Clinic Administration

    Effective Date: 01/30/2023

    Policy and/or Procedure:

    Patients must be reachable by the Provider to schedule, confirm, and cancel/reschedule appointments. Arrangements must be agreed upon mutually at the intimation of the Patient-Provider Relationship.

    >48H/2 days before the appointment OR before the first Intiveo confirmation is made

    • Provider communicates with the patient to cancel and reschedule the appointment. 
    • Provider documents the communication in Contact Notes
    • Provider cancels the appointment in axiUm and indicates >48h reason code

    <48h/2days before appointment AND after Intiveo confirmation has been made

    • Provider communicates with the patient to cancel and reschedule the appointment. 
    • Provider has response from patient via voice or message acknowledging cancelation and rescheduled appointment. 
    • Provider documents the communication in Contact Notes
    • Provider cancels the appointment in axiUm and indicates <48h reason code
    • The patient’s appointment should NOT be canceled unless there is confirmation that the patient received notice of the cancelation

    If the Provider does not have acknowledgement from the Patient:

    • Provider must present for the appointment in the SOD
      • If there is an emergency or conflict, the Provider must make arrangements for another provider to see the patient.
      • PCC and GP Director must be informed.

    Appointment Confirmation Policy

    • All patient appointments should be confirmed 48h in advance of the scheduled date and time. 
      • Automated process via Intiveo AND/OR communication between provider and patient. 
      • If the Provider is not able to get in touch with the patient, they must still be present for the appointment and wait the appropriate amount of time (30 minutes) before failing the appointment.
        • They should cancel the appointment in axiUm and document the failed appointment as a general note which the faculty must approve.  

    Patient Care Finances Policy

    Subject: Class III – Clinical – H. Patient Administration

    Reviewed and/or Revised: 09/01/2017

    Purpose

    To inform the patient of their financial obligation should they obtain treatment

    Policy Statement

    • All treatment must be paid in full at each treatment appointment unless a Patient Financial Agreement or other arrangements have been approved.
    • An emergency patient without immediate funds will be treated only with an instructor's written authorization in the record.
    • If dental insurance, third-party coverage, or other prepaid financing covers the patient, procedures requiring preauthorization approval must be obtained before treatment is initiated.
    • Dental students are responsible for collecting the full fee and informing each patient about payment procedures.
    • Elective treatment may be discontinued, at the direction of the G.P. Manager, for patients whose balance is unpaid or overdue for 60 days or more.
    • Dental and dental hygiene students, their spouses and children are eligible for special fee reductions in the predoctoral program. These individuals may receive predoctoral treatment at no cost, except inlays, onlays, fixed and removable prosthodontic procedures and predoctoral orthodontics that will be at 50 percent of the predoctoral clerkship fee. Students are not eligible for other reduced fees.

    Patient Check In and Out Policy and Procedure

    Subject: Class III – Clinical – H. Patient Administration

    Policy Reviewed and/or Revised: 09/01/2017

    Policy Statement

    To ensure that all patients who present with an appointment for the day are checked into and checked out of the system.

    Purpose

    To ensure that all patients who present with an appointment for the day are checked into and checked out of the system at the conclusion of their visit.

    Policy and/or Procedure

    Patient Check In:

    1. The patient is greeted by the Front Desk Staff.
      1. Front Desk Staff verifies that the Patient is presenting to the correct clinic.
        1. If patient is presenting to the correct clinic, proceed to number 2.
        2. If patient presents to the incorrect clinic and is unsure as to which clinic to present to, via scheduler, locate the “correct” clinic for the patient’s appointment and assist the patient with reporting to the “correct” clinic.

          Note: The treating clinic is to check- in the patient. If it is a Pre-doctoral Student seeing a patient in the Endodontics Clinic, the Pre-doctoral Clinic is to check-in the patient.

    2. The appropriate Front Desk Clinic Staff will check the Patient into the Axium System from:
      1. Scheduler (insert document)

        Note: Rolodex (insert document) is only to be used in the Screening Department, new patients that are not currently in Axium and for any unscheduled or walk in appointments. Checking the patient in by using Rolodex will show patient as being checked in for all appointments scheduled for that day.

      2. Patient may be added as a new patient (take to registering a new patient link)
        1. In the scheduling database, the receptionist right clicks on the patient’s name and chooses “check- in“. This turns the patient’s name to “red”, which alerts the provider their patient has arrived and is in the waiting area.
        2. To check a patient in from Rolodex:
          1. Locate the patient via Rolodex.
          2. Double click on today’s scheduled appointment. This will take you to scheduler.
          3. In the scheduling database, the receptionist right clicks on the patient’s name and chooses “check- in“. This turns the patient’s name to “red”, which alerts the provider their patient has arrived and is in the waiting area.
        3. Front Desk Staff confirms Patient’s personal information such as:
          1. Address
          2. Phone number
          3. Insurance information
        4. Front Desk Staff are responsible for correcting any changes noted.
        5. Front Desk Staff will check the patient’s financial account status, advise patient of any balance due and to please request to remit payment via cash, check or credit card.
        6. Patients with balances over 30 days old, may be put in contact with a supervisor to make payment arrangements.
    3. The provider or assistant greets the patient and walks the patient back to the clinic for services to be rendered.
    4. The patient is seated.
    5. In Axium, the provider right clicks onto the patient’s name and selects”patient seated”, which turns the patient’s name from red to black.
    6. Receptionist is to monitor the waiting area to ensure that all patients have been assisted and their providers are aware they are waiting (via check in).

    Patient Check Out:

    1. Prior to dismissing a patient, an Axium treatment code must be entered and approved by Faculty as appropriate.
    2. The Patient is escorted back to the Reception Desk to be checked out of Axium.
    3. Front Desk Staff will review treatment transactions and requests payment as appropriate.
    4. The Front Desk Staff will right click onto that patient’s name, chooses “check out”, which turns name from black to gray, signifying that all dental and financial transactions have been completed.
    5. The next appointment is scheduled (if applicable). Note: This may be done at the Reception Desk or at the chair by the Student/Resident depending on the guidelines for that clinic.
    6. Patient is given a parking validation, if needed, and dismissed.

    Patient Complaints and Grievances Procedure

    Subject: III. Clinical – H. Patient Administration

    Effective Date: 7/28/15 

    Reviewed and/or Revised: 08/26/2015, 09/11/2016, 05/26/2017, 09/01/2017, 12/17/2018, 04/18/2019

    Definitions:

    Complaint: A written or oral expression that indicates a dispute with the Dental School or a Dental School Policy.

    Grievance: Refers to a verbal or written statement by the Patient that expresses dissatisfaction with some aspect of service(s) received that the Patient wants to resolve, which has not been resolved between Student, Resident, Faculty, Staff and Patient

    Policy and/or Procedure:

    1. Complaints/Grievances regarding non-treatment issues which involve staff/faculty behavior/professionalism may be forwarded to the employee's supervisor or to the Director, Medical Credentialing and Quality Assurance. When received by either the Director of Medical Credentialing and Quality Assurance or the employee’s supervisor, it will be coordinated with the Faculty who handles complaints and GP/Program Directors with a copy to HR. The employee will be notified by the supervisor and appropriate actions taken.
    2. Complaints/grievances are usually communicated to the Faculty who handles complaints and the GP/Program Director. Complaints/grievances of a confidential nature may be communicated directly to the GP/Program Director or to the Director, Medical Credentialing and Quality Assurance, which will be sent to the Faculty who handles complaints and the GP/Program Director for resolution.
    3. A notice is visible in the reception area giving the phone number that Patients can call inviting them to share their experience and/or register a complaint/grievance. This number is for the Patient Care Coordinator who will refer them to the appropriate GP/Program Director.
    4. GP/Program Directors will assist with resolving the issue before it becomes a formal complaint.
    5. If the GP/Program Director cannot resolve patient’s issues at hand, the GP/Program Director notifies the appropriate Faculty member who handles complaints, Department Chairman via email with a copy to the Business/Office Manager and the Director, Medical Credentialing and Quality Assurance. Complaints regarding Faculty or Students will be given to the Department Chairman with copies to the Director, Medical Credentialing and Quality Assurance and the GP Director/Program Director. Complaints regarding Staff persons will be sent to Faculty member who handles complaints with a copy to the GP/Program Directors for resolution with a copy to HR and the Director, Medical Credentialing and Quality Assurance. A written acknowledgement will be sent by the Director, Medical Credentialing and Quality Assurance and a phone call to the patient will be made by the Faculty member who handles complaints. The Faculty member who handles complaints will review the patient’s file with the GP/Program Directors, and advise the students/residents.
    6. If the complaint/grievance involves a business matter, then it is sent to the Business/Office Manager to take action by the Faculty Member/GP/Program Director, with a copy to the Director, Medical Credentialing and Quality Assurance. Once the complaint reaches the Director, Medical Credentialing and Quality Assurance, the Director, Medical Credentialing and Quality Assurance logs the complaint and/or grievance. The complainant may leave a verbal complaint, but will be requested to send the complaint in writing via USPS, email or fax to the Director, Medical Credentialing and Quality Assurance. Information to be logged would include date received, date complaint is acknowledged, patient name, confirm address in system, Axium ID number, phone number, email address, description of complaint/grievance, resolution requested by patient, action taken to resolve, date resolved. Data is to be gathered for QA purposes and reported to the QA Committee by the Director, Medical Credentialing and Quality Assurance.
    7. Once the complaint/grievance reaches the Director, Medical Credentialing and Quality Assurance, it will be logged in (as per section 6) and reviewed by the Faculty member handling complaints and the GP/Program Director. The Faculty member handling complaints using the gathered information he/she received directly from the patient’s record, providers, discussions with Students, Residents, Staff, and Faculty who were involved with treating the patient, will develop and write a resolution letter to the patient regarding the complaint/grievance with a copy to all necessary parties. Resolution letters may not be written for less complex complaints. These less complex complaints are resolved verbally with the patient. If a financial adjustment to the patient’s account is to be performed, the Faculty member handling complaints and/or the Director, Medical Credentialing and Quality Assurance, will notify the Senior Business Manager of Business Operations so they may ensure that the financial adjustment has been made to the patient’s account. Clinic Business Manager(s) will complete financial adjustments according to policy and procedure. 
    8. The Faculty member handling the complaints and the GP/Program Directors will notify the Director, Medical Credentialing and Quality Assurance of all actions toward resolution as they are completed and give copies of documentation to that effect. All actions taken toward resolution will be given to the Director, Medical Credentialing and Quality Assurance by the Faculty member handling complaints and the GP/Program Director who will add a copy of resolution letter to the Patient’s Record.
    9. If a patient is not satisfied with the resolution, they may appeal the resolution. The Faculty member handling complaints will review the complaint/grievance and resolution with the Associate Dean of Clinical Affairs. The Associate Dean of Clinical Affairs will consider the information that had been reviewed and any new information that may have been presented (including additional review with UMSOD personnel). The Associate Dean of Clinical Affairs will either support the original resolution, modify the resolution, or propose a new resolution. The decision of all appeals will be in writing.
    10. Patients may appeal the decision of the Associate Dean of Clinical Affairs to the UMSOD Dean. The UMSOD Dean will confer with the Associate Dean of Clinical Affairs to determine if additional review is warranted. The UMSOD Dean will review pertinent documentation as listed in #7 above and other information associated with the complaint and render a decision to support or propose an alternative resolution. 

    Patient Records Policy

    Subject: III. Clinical – H. Patient Administration

    Policy/Procedure: Patient Records Policy

    Effective Date: 8/19/13

    Reviewed and/or Revised: 09/01/2016, 09/01/2017

    Policy and/or Procedure:

    • All current patient records are maintained by the IT Department via Axium, Romexis and MiPacs. Pre EPR records can be ordered from storage.
    • The patient EPR is the official document for patient history, provision of care, and documentation of patient progress. As such, it is critical that all entries be accurate and current. The EPR is designed to confirm to the most recent criteria for standards of care.
    • Patient disposition notations and provider changes are noted in the EPR.
    • Referral notes are made in the EPR.
    • Patients have access to complete and current information about their dental conditions.
    • The EPR will include all diagnostic and treatment services provided by UMSOD.
    • Upon receipt of a written request from a patient or parent/guardian and payment of a reasonable fee, the record and radiographs will be duplicated and provided by the Medical Records Supervisor (Room 5201).
    • Patient records are the property of the UMSOD.
    • When a record request is made by an attorney or through a court ordered subpoena or by the Board of Dental Examiners, the records are reviewed by Faculty prior to forwarding.

    Only members of the Clinic Administration are authorized to correct EPR errors in patient records. Errors corrected may include entries made into wrong EPR charts, duplicate entries, and blank EPR forms.

    • Records must be handled in full compliance with HIPAA regulations.
    • Recourse for non-compliance is academic counseling.

    Patient Records – Progress Notes

    Subject: III. Clinical - H. Patient Administration

    Effective Date: 06/07/2016

    Reviewed and/or Revised: 09/01/2017

    Effective 7/11/16, all residents and pre-doc students will be required to select the name of the “Covering Faculty” for all procedures. For faculty performing a procedure, they are to select their own name.

    Notes can be created in several ways:

    1. Note manually typed freehand via Template Notes

    Select Tx History tab

    Tx History Tab

    1. Click on the “add a new note” symbol (second green PLUS sign)
    2. A box will pop up; click on the square next to CODE
    3. This will give the dropdown list of type of template notes to select from

    Template Note- Patient

    Clinical Note Codes List

    If you wish to enter your chart note free-hand click on “General Note” or “SOAP/ATEN Note”

    To enter the note, click on {*Required} which will bring up a box to type in your chart note

    Enlarged Template Note-Patient

    Click on Covering Faculty {*Required}, type first character of last name then select from the dropdown list of faculty.

    2. Note via multi-disciplinary VISIT form.

    1. Appointment Provider must add the form. Go to Forms tab, click on “add a new record” icon
    2. An “Add Form” box will pop up; click on the dropdown list in “Form” and select the “VISIT Form” and hit “ok”
    3. This “Visit Form” is a fill-in-the-blank / dropdown multidisciplinary question set that automatically creates a progress note. After the form is reviewed and approved, the progress note is added to the patient’s chart under the Tx History tab. Pink highlighted areas are required to be filled out in order to complete the form. Entering the Covering Faculty is one of the areas that is required in order to complete this note successfully.

      **A Built in option for addendum and/or corrections to this note is available when you scroll down to the bottom of the Visit Form.

    For additional information and an online demo of the complete process for creating a progress note using the VISIT form, access “Visit Form Progress Note” via Axium Links

    Patient Treatment Redo’s - Patient Complaint Policy

    Subject: III. Clinical - H. Patient Administration

    Department: Clinical Affairs

    Reviewed and/or Revised: 09/01/2017

    Purpose: Addressing deficient dental care.

    Policy and/or Procedure:

    From time to time it becomes necessary to redo, repair, modify or replace failed or failing dental treatment. If the treatment under consideration was inadequate upon placement, or if it failed shortly after placement, the UMSOD may decide to modify, replace, or repair it at a reduced fee or at no charge to the patient. In such cases, the faculty involved will prepare an adjustment form stating the problem, the recommended corrective measures, and recommended fee adjustments. This adjustment form will be signed by the appropriate faculty and business manager with a copy to the Director, Medical Credentialing and Quality Assurance.

    Patients shall be told the situation is being referred for faculty review to consider corrective measures, however, no one should mention any specific remedy to the patient at this time. The adjustment form will be presented to the Director, Medical Credentialing and Quality Assurance for review, appropriate approval, or modification. If the recommendations of the Faculty handling complaints are accepted by the patient, treatment may begin. If results are not accepted by the patient, the patient will have the right to file a formal complaint for further review.

    This policy applies in the UG and PG clinics. In the Undergraduate (UG) Clinics the GP Directors should sign the adjustment forms.

    Patients Accompanied by Non-Patients and/or Minors While in Dental Operatories or Surgical Areas

    Subject: Class III – Clinical – H. Patient Administration

    Department: Oral Surgery

    Effective Date: 9/13/13

    Reviewed and/or Revised: 09/01/2017 

    Purpose: Accompanied and/or Unaccompanied Children in Clinical Areas

    Policy and/or Procedure:

    For privacy and safety reasons, only the patient scheduled for dental treatment is permitted in the dental operatory during the delivery of care. However, if extenuating circumstances warrant, a clinical faculty member may determine that an individual other than the scheduled patient may also be present in the dental operatory during treatment. Relatives, friends, and children accompanying scheduled patients should wait in the reception area. Children under the age of 12 cannot wait in the reception area unsupervised. UMB School of Dentistry faculty, staff, residents or students will not be responsible for the welfare or supervision of unaccompanied children in the reception area.

    Phone Calls Processing Procedure: a. Office of Attorney General and; b. Patient Calls

    Subject: III. Clinical - H. Patient Administration

    Effective Date: July 2016

    Reviewed and/or Revised: 05/26/2017, 09/01/2017

    Office of the Attorney General (OAG) phone calls:

    • All Office of the Attorney General (OAG) phone calls are to come thru the Director of Medical Credentialing and Quality Assurance and sent to 410-706-7306.
    • The patient or the Office of Attorney General’s Office may also leave a voicemail message which will be acknowledged by email or letter. They will also receive a phone call within 24-business day hours from the Director of Medical Credentialing & Quality Assurance or the Faculty who handles complaints. It would be helpful if the OAG office left the times they would be able to receive a phone call back and their email address.

    Patient Complaint Calls:

    The protocol in place for patient complaint phone calls to be handled in a most efficient manner and also for legal and liability purposes is as follows:

    • All patient complaint phone calls are to come thru the Director of Medical Credentialing and Quality Assurance and sent to 410-706-7306.
    • The patient may also leave a voicemail message which will be acknowledged by email or letter. They will also receive a phone call within 24-business day hours from the Director of Medical Credentialing or the Faculty who handles complaints. It would be helpful if the patient left the times they would be able to receive a phone call back and their email address.
    • When a patient leaves a voicemail message, they will be sent an acknowledgement email within 24-business day hours or a letter via Federal Express the same day so they receive it the next day.
    • The patient will be informed of the protocol and requested to put the complaint in writing and email it to: emarkwitz@umaryland.edu or UMSOD, 650 W. Baltimore St., Suite 5201, Baltimore, MD 21201 to Director of Medical Credentialing and Quality Assurance’s attention.
    • The Director of Medical Credentialing & Quality Assurance will log the complaint.
    • The Director of Medical Credentialing and Quality Assurance will refer the complaint and information to the appropriate Faculty who handles complaints with copies to providers and/or staff as necessary to provide further information for resolution.
    • The Faculty who handles complaints will review the information with Faculty, providers and staff and contact the patient via a phone call(s). A letter with a resolution will be sent to the patient when the complaint is resolved.
    • If the patient is appealing or still not satisfied with the resolution provided, the complaint would again come thru the Director of Medical Credentialing and Quality Assurance who would log it as an Appeal. Appeals would be sent to the Assistant Dean for Clinical Affairs for further consideration and/or resolution. A letter and/or email of the decision would be sent to the patient.

    Policy For Treating Patients Under the Influence of Alcohol and or Drugs

    Subject: III. Clinical – H. Patient Administration

    Effective Date: 09/14/2022

    Reviewed and/or Revised: 09/14/2022

    Policy and/or Procedure:

    Patients who are under the influence of alcohol and/or drugs are incapable of providing Informed Consent. Therefore, unless it is a life-threatening emergency; dental treatment at the UMSOD should be deferred until the patient is no longer under the influence of alcohol and/or drugs and the patient is capable of providing Informed Consent.

    UMB/UMSOD Policy For Known or Suspected Monkeypox Cases: August 2022

    First priority is to prevent exposure of employees or patients!

    • Immediately Isolate patient to dental chair
    • Keep patient seated
    • Patient should wear a mask and cover all skin lesions, as much as possible
    • Anyone with contact should don gown, gloves, face shield, and N95 or equivalent respirator
    • Provide medical consultation including stressing the importance of prompt follow-up with a physician, and dismiss patient ASAP
    • Immediately contact the Baltimore City Health Department (BCHD) or Maryland State Department of Health (MDH) to report the case, including providing patient contact information
    • BCHD: (410) 396-4436, or after hours: (410) 396-3100
    • MDH: (410) 767-6700, or after hours: (410) 795-7365
    • CDC: (770) 488-7100, if additional clinical guidance is needed CDC: (770) 488-7100, if additional clinical guidance is needed
    • Do not take samples of lesions or make direct skin contact as part of the physical exam
    • Contact 410-328-2637 or UMBOccupationalHealth@som.umaryland.edu for additional assistance, including to discuss any potential exposure concerns
    • Once patient leaves the operatory/clinic, consult EHS for proper decontamination protocols (410-706-7055 from 8-4 M-F, otherwise 410-706-6665). Per EHS instructions, perform surface disinfection to all operatory surfaces and dispose of all PPE, including gowns, in the special medical waste containers surfaces
    • More information on waste management can be found here: Infection Prevention and Control of Monkeypox in Healthcare Settings
    • For those working in UMMS sites, please follow UMMS guidance

    Policy on Photography Recording and Videotaping in the UMSOD Clinics

    Subject: III. Clinical - H. Patient Administration

    Department: Clinical Affairs

    Effective Date: 02/13/2024

    Reviewed and/or Revised: N/A

    Policy and/or Procedure:

    In order to protect patient, faculty, staff, and student/resident privacy; the UMSOD prohibits any form of Photography, Recording, and/or Videotaping by patients and/or visitors in the clinic spaces or during dental treatment.

    Prescriptions- Oral and Maxillofacial Surgery Residents

    Subject: III. Clinical - H. Patient Administration

    Department: Clinical Affairs

    Effective Date: 05/01/2015

    Reviewed and/or Revised: 09/01/2017

    Policy and/or Procedure:

    • OMFS Residents may only write prescriptions under the DEA of the medical center for patients of the UMMC hospital.
    • OMFS residents may not use the DEA provided by the medical center to write prescriptions for patients seen at the UMSOD Dental clinics.
    • OMFS residents may only prescribe while in the UMSOD Dental clinics if they are a licensed Maryland Dentist with their own DEA and NPI number.
    • While in the UMSOD Dental clinics, the OMFS residents must obtain all prescriptions for the patients they are treating in the Dental School from the faculty that are overseeing the clinic at that time. The OMFS resident will present the patients’ medical history and the procedure that has been performed on their patient as well as the medication, dose and regimen that they wish to prescribe to their patient. The Dental Faculty will then write and sign the prescription and document this in the Dental Axium chart.

    Purging and Destruction of Patient’s Paper Medical/Dental Chart Records

    Subject: III. Clinical - H. Patient Administration

    Department: Clinical Affairs

    Origination Date: 01/01/2014

    Effective Date: 01/09/2014

    Reviewed and/or Revised: 09/01/2017

    Purpose: Guidelines for purging and destruction of patient’s paper medical/dental chart records.

    Policy and/or Procedure:

    All medical/dental chart records, laboratory, X-ray reports or photographs about and regarding patients may not be destroyed for 5 years after the last report has been made.

    In the case of a Minor Patient, all medical/dental chart records, laboratory, X-ray reports or photographs about and regarding patients who are a minor may not be destroyed until the patient attains the age of majority (21 years old) plus 3 years or 5 years after the last record or report is made, whichever is later.

    A letter sent by first class mail to the last known address of the patient’s parent or guardian shall be sent informing them of the intent to destroy the records unless advised in writing within 30 days of notification. If after 30 days from the mailing of the letter there is no response or if the letter is returned with no forwarding address, then the record will be destroyed.

    Receiving Direct Payment for Services (Cash, Check, Charge or Debit Card)

    Subject: III. Clinical - H. Patient Administration

    Reviewed and/or Revised: 09/01/2017

    Purpose

    The purpose of this procedure is to manage direct payments for services rendered to patients.

    Policy and/or Procedure

    1. Pays for services rendered with cash performed by patient.
    2. Note payment received in the system performed by receptionist.
    3. Patient given receipt, performed by receptionist.

    Referring a Patient to Secondary Provider Procedure

    Subject: III. Clinical - H. Patient Administration

    Department: Clinical Affairs

    Effective Date: 08/19/2013

    Reviewed and/or Revised: 09/01/2017

    Purpose: Support Patient Administration Policy

    Policy and/or Procedure

    In an emergent situation outside scope of student capability:

    1. Evaluate status of patient and makes recommendation performed by faculty
    2. Document recommendation in patient progress note performed by faculty
    3. Referral form filled out and approved by faculty in EHR.
    4. Advise student to escort patient to specialty clinic and/or place appropriate notes in EHR Medical health history to be approved by faculty.
    5. Make arrangement for patient to be seen, may be performed by PCC
    1. Student consults GP Director or Assistant GPD
    2. GP Director or AGPD documents decision for limited care by a "secondary student provider"
    3. Student obtains Request for Patient Referral form and notes specific service being referred.
    4. GPD or AGPD approval needed.
    5. PCC Notified by student after approval obtained.
    6. PCC adds a provider assignment box of AxiUm with a comment noting that the additional student is a secondary provider

    Refresh Button for Patient Records

    Subject: Clinical III. – H. Patient Administration

    Department: Clinical

    Effective Date: 11/20/18

    Reviewed and/or Revised: 12/12/18

    In order to ensure patient records are up-to-date with the most recent patient information in Axium for a records release, please do the following going forward for EVERY patient after EVERY prescription is written:

    1. Select Patient in AxiUm Rolodex.
    2. Click on the E.H.R.
    3. Go to Medications tab.
    4. Click the REFRESH button

    Image of Refresh button procedure for records release

    Note: The Faculty member or Student must click the refresh button to ensure that all prescription and allergy data goes back into Axium. This action should be performed routinely by all Faculty and Students and is especially important when using a mobile app to prescribe medications. Please know that after a prescription is written and approved in iPrescribe, the iPrescribe mobile app doesn’t “sync” the information back into Axium. Hence, the need for the refresh button. 

    Please let the Sr. Business Manager of Business Operations know if you have any issues accessing this feature.

    Requesting Adjustment of Patient Account Procedures

    Subject: III. Clinical - H. Patient Administration

    Reviewed and/or Revised: 09/01/2017

    Purpose

    To adjust patient’s account that may include but not limited to: to be in compliance with financial contracts, to provide an act of good will toward patient.

    Policy and/or Procedure

    Obtain rationale for the adjustment to include but not limited to:

    • Redo- Depending on rationale, an outcome assessment form may need to be completed and signed by appropriate faculty member. Form is then given to accounting clerk to perform adjustment to patient’s account.
    • Contractual Agreement - If form is not needed, i.e., due to a contractual agreement, accounting clerk adjusts the patient’s account to be in accordance with the contractual agreement.
    • Overdue Account - If patient’s account has a balance that is overdue by 120+ days, the account is adjusted to zero balance. The account is forwarded to the State Central Collection Agency.
    • Patient Courtesy – Depending on circumstance, a patient courtesy may be extended as a good will gesture.

    Requesting Duplication of Patient Records

    Subject: III. Clinical – H. Patient Administration

    Effective Date: 8/19/13

    Reviewed and/or Revised: 09/01/2016, 09/01/2017

    Upon receipt of a written request and signed authorization from a patient or parent/guardian and payment of a reasonable fee, the record and radiographs will be duplicated and provided by the Medical Records Supervisor (Room 5201).

    • If paper chart record is offsite, Chartroom Supervisor requests chart record from archive location.  Note: This may take approximately 4 days to receive.
    • Once chart record is received, x-rays may be sent to be scanned.
    • Once x-rays are scanned, they are duplicated.  
    • Requestor is notified to pick up record or it can be mailed.

    Note: If patient brought x-rays into the Dental School and is requesting them back, the Chartroom Supervisor scans x-rays and places scanned copy in the patient’s chart record.

    • Patient records are the property of the UMSOD.
    • When a record request is made by an attorney or through a court ordered subpoena or by the Board of Dental Examiners, the records are reviewed by Faculty prior to forwarding.

    Requests for Discounted or Free CBCTs Policy

    Subject: Clinical III. – H. Patient Administration

    Department: Oncology and Diagnostic Sciences

    Origination Date: 04/30/2024

    Effective Date: 04/30/2024

    Purpose: Define the write-off process for CBCT radiographs  

    • Radiology cannot write-off fees for other departments. 
    • If programs want to provide CBCTs at reduced fee or free, the program will have to provide the funding source to cover the expense. 

    Terminating Dental Provider - Patient Relationship Policy and Procedure

    Subject: III. Clinical – H. Patient Administration

    Department: Clinical Affairs

    Origination Date: 1/1/2009

    Effective Date: 1/1/09

    Reviewed and/or Revised: 07/01/2016, 05/08/2017, 09/01/2017, 04/17/2019

    Purpose: Follow proper procedure to terminate the dental provider-patient relationship ensuring that abandonment of patients does not occur. Faculty and Clinic Administration will ensure that the decision to terminate a dental provider – patient relationship is appropriate and/or necessary and that patients are properly advised of the decision.

    Definitions: Abandonment – termination of a professional relationship between dentist and patient at an unreasonable time and without giving the patient sufficient opportunity to find an equally qualified replacement

    Policy and/or Procedure:

    Once a dental provider-patient relationship is established, a dentist is under both an ethical and legal obligation to provide services as long as the patient needs them. There may be times, however, when you may no longer be able to reliably provide care. It may be that:

    The patient is:

    • Not compliant with policies or procedures
    • Unreasonably demanding with treatment or clinic policies
    • Threatening and/or abusive to the dental provider and/or staff
    • Not paying bill(s) for dental services rendered
    • Taking legal action against the dental provider, contributing to the breakdown of the dental provider-patient relationship
    • Unwilling to accept treatment recommendations

    Or the dental provider is:

    • Relocating
    • Retiring
    • Limiting practice
    • Or there is unanticipated termination by a managed care plan and/or employer

      Regardless of the situation, to avoid a claim of “patient abandonment”, a dental provider must follow appropriate steps to terminate the patient-dentist relationship.

    Terminating the relationship should be the last resort and except in extreme cases should occur only after advising and warning the patient that continued behavior will result in termination. These advisories and warnings must be documented in the patient’s chart. The dental provider-patient relationship will only be terminated if the supervising faculty agrees with and approves of this action. Faculty approval must also be documented in the patient record.

    Hallmarks of proper procedure are reasonable notice of intent to terminate and adequate time for patient to find alternate care before termination takes effect. The following is the procedure when terminating dental provider-patient relationship:

    1. Provide written notice of termination of relationship (see letter template below).
    2. Mail letter certified mail return receipt requested.
    3. Specify effective date of termination (Note: patient may be treated in Urgent Care Clinic for emergency or urgent treatment until termination date).
    4. Advise patient in letter of any unfinished treatment, the need for continued care, and the risk of not continuing current and future dental treatment.
    5. Provide adequate time for patient to find another provider (30 days). Patient can obtain emergency or urgent care treatment if needed for 30 days
    6. Assist patient to transfer care to another provider.
    7. Provide the Maryland State Dental Association 410-964-2880 as a resource for patient to identify another provider.
    8. Provide dental record to new provider upon request (with patient signed authorization.
    9. Document in patient’s chart record and scan copy of notification letter.
    10. Place office code DNR on patient’s account.
    11. Advise the clinic Director, Program Director, and the Associate Dean of Clinical Affairs.
    • Other References: UMB Risk Management
    • Recourse for non-compliance: Academic Counseling; Suspension of Clinical Privileges

    Sample Termination of Care Letter:

    Date

    name

    address

    address

    Dear name:

    The purpose of this letter is to inform you that the University of Maryland, School of Dentistry has decided that we must terminate our dental provider-patient relationship with you due to (EXPLAIN REASON). Effective immediately, the School of Dentistry will not begin any new dental treatment.

    As of the date of this letter, there are (DESCRIBE TREATMENTS THAT HAVE BEGUN AND EXPLAIN THAT THEY NEED TO BE COMPLETED). We will complete those treatments if you are willing to do so. You will be financially responsible for all treatment that is completed and will be charged accordingly.

    For the next thirty days, the School of Dentistry will remain available to you to provide emergency treatment only through the Urgent Care Clinic. Please phone (410) 706-2716 to arrange an emergency appointment.

    It is recommended that you identify a new dentist as soon as possible to continue your dental care. Failure to continue with care could result in a worsening of your oral condition, including possible pain, infection, swelling and/or tooth loss. If you need assistance in selecting another dental provider, you may wish to contact the Maryland State Dental Association at (410) 964-2880.

    At your request, we will forward a copy of your dental record to your next provider. Attached please find a Records Request Form for your convenience and for you to complete if you would like a copy of your dental record forwarded.

    Thank you for your past confidence and for allowing the University of Maryland, School of Dentistry to treat your dental needs.

    Sincerely,

    (Patient Care Coordinator, Director, Program Director, Associate Dean of Clinical Affairs)

    Transferring Patients from Perryville Clinic to UMSOD

    Subject: III. Clinical – H. Patient Administration

    Effective Date: 10/7/16

    Reviewed and/or Revised: 09/01/2017

    Policy and/or Procedure:

    Patients will be transferred to or referred to UMSOD in Baltimore when the Perryville Faculty feel the patient’s needs are beyond the capability of a fourth year dental student

    Perryville comprehensively treats people over 21 and over 60 that are compromised. Perryville sees under age 21 for comp care. Faculty will refer patients to ASE downtown or AGD when necessary. If predoc, Perryville, will keep the patient. Faculty will send referrals the same way as if they are coming from an outside dentist.

    As far as treatment planning, Perryville will not treatment plan nor quote fees for the referrals to UMSOD. If an Endo patient, Faculty will refer the patient directly to UMSOD Endo and Endo can refer the patient back to Perryville afterwards. They will be direct referrals.

    Perryville does Ortho (thru a private practice), transitional partial, caries control and has a complete hygiene program for any age. Perryville has Endo Faculty and residents on Mondays and otherwise patients will be referred to UMSOD downtown. Perryville can do the core and crowns.

    Definitive restorative will be done in Perryville. If Perryville is not doing restoration make a note of that too in the patient’s chart. These cases will not be referred to UMSOD ASE Pros. The patients will be given a referral to AGD as an option since Perryville is a limited care facility.

    Regarding implants, if the patients are referred downtown they will be referred to ASE or AGD for restoring. Single implants that need crowns can be sent to predoc who would be able to treatment plan.

    Transferring Patients to Residents, Diamond Scholars in AEGD Clinic

    Subject: III. Clinical – H. Patient Administration

    Effective Date: 8/5/15

    Reviewed and/or Revised: 09/01/2017

    Purpose: This checklist would be most useful at the beginning of the school year when we get all the new residents and Diamond Scholars and they inherit all the patients from prior Residents and Diamond Scholars. This checklist is a quick and good QA check for us with more controls in the clinic and more controls for the faculty and students.

    When patients are transferred from predoc or from one AEGD Resident to another, the checklist below can help us to actively look for things often missed. The attending faculty should review the checklist and ensure that appropriate actions are taken. Once the faculty reviews it, the checklist is deleted and each resident can store the empty checklist in a folder and recall as needed.

    Policy and/or Procedure:

    AEGD: Pathway for Patients Transferred to AEGD Resident or Diamond Scholar

    Instructions: Store the empty checklist template in a folder. Complete this checklist for all patients transferred to you at their first visit. Faculty will review the checklist. After the checklist has been reviewed, clear the fields.

    Axium#_________________Date__________

    __Chief Complaint was reviewed and confirmed

    __Chief Complaint was not reviewed or confirmed

    __No Chief Complaint has been recorded

    __Patient had a comprehensive or recall exam within the last 12months

    __Patient has not had a comprehensive or recall exam within the last 12months

    __Medical history was not reviewed

    __Medical history was reviewed and changes in medical history or drugs were recorded prn

    __Medical history was reviewed and patient needs lab work or medical consult or prior consult was not returned

    __There are no urgent oral problems

    __There are urgent oral problems that need to be treated (pain, swelling, loss of function, etc.)

    __Patient has a treatment plan, treatment sequence and comprehensive fee schedule

    __Patient does not have a treatment plan, treatment sequence or comprehensive fee schedule

    __Implants are planned and patient has had FM probing and a periodontal diagnosis

    __Implants are planned and patient has not had FM probing or a periodontal diagnosis

    __Crowns or bridges are planned and there are recent periapical radiographs of the planned teeth

    __Crowns or bridges are planned and there are no recent periapical radiographs of the planned teeth

    __Patient finances are in order

    __Patient finances not not in order

    __Patient does not have any failed treatment done at the School that needs to be redone

    __Patient has failed treatment done at the School that needs to be redone

    __Patient is wearing a temporary crown, bridge or denture and it needs to be replaced with another temporary until the permanent prosthesis is delivered

    __Patient is not wearing a temporary crown, bridge or denture

    __Patient has temporary restorations (fillings)

    __Patient does not have temporary restorations (fillings)

    __Patient has endo in progress

    __Patient does not have endo in progress

    Treatment Planning Policy – Predoctoral Clinic

    Subject: III. Clinical – H. Patient Administration

    Origination Date: 6/1/08

    Reviewed and/or Revised: 09/01/2017

    Purpose: Ensure accurate diagnostic data is compiled in order to develop an appropriate treatment plan.

    Definitions: TPW- Treatment Plan Work up

    Policy and/or Procedure:

    Accurate diagnostic data gathered and recorded are essential for developing a patient’s treatment plan. During the treatment plan work up appointment (TPW) information is entered into the Electronic Health Record (EHR), including the Caries Risk Assessment, Periodontal Charting, EOE/IOE, TP Primer, TMD/occlusion, Treatment History, Medical History, Dental History, and other discipline based forms. Diagnostic Models, appropriate radiographs, and intraoral images need to be obtained.. Individual patients may require additional information including but not limited to medical consults, laboratory results, and in some cases legal authorization to treat. If you have questions, consult faculty to make sure all necessary data/information has been attained. This information is the basis for decision-making and formulating a treatment plan for the patient.

    Note: Treatment plans must include the patient, student and appropriate faculty consent signatures before treatment services are rendered. Failure to obtain signatures implies there is no informed consent. Since this is such an important issue, such failure will result in an N or a U grade in professionalism for that session. Repeated offenses may result in generation of a counseling report.

    Recourse for non-compliance: 

    1. Student may receive an N or U grade for both Professionalism and/or the Clinical Procedure on their daily grading form in Axium. An N or U grade in Professionalism will negatively impact their grade in Comprehensive Care and Patient Management 538 and/or 548. 
    2. Academic Counseling Report will be generated that may lead to Dean’s counseling, suspension from clinic, or judicial board review.

    Laws, Regulations, Standards, etc. that must be observed:

    Entering Treatment into Axium

    Patient Records Management Procedure

    Obtaining Informed Consent

    ADA Guidelines/Ethics

    Treatment Planning Procedure

    Subject: III. Clinical – H. Patient Administration

    Effective Date: 8/19/13

    Reviewed and/or Revised: 09/01/2017

    Purpose: Accurate diagnostic data gathered and recorded are essential for developing a patient’s treatment plan. During the treatment plan work up appointment (TPW) information is entered into the Electronic Health Record (EHR), including the Caries Risk Assessment, Periodontal Charting, EOE/IOE, TP Primer, TMD/occlusion, Treatment History, Medical History, Dental History, and other discipline based forms. Diagnostic Models, appropriate radiographs, and Intraoral Images need to be obtained on the patient. Individual patients may require additional information including but not limited to medical consults, laboratory results, and in some cases legal authorization to treat. If you have questions, consult faculty to make sure all necessary data/information has been attained. This information is the basis for decision making and writing a treatment plan for the patient.

    Definitions: 

    • TPW: Treatment Plan Work up
    • TXP: Treatment Plan Presentation
    • TPU: Treatment plan up-date

    Pre-Requisite:

    Students must be unconditionally advanced to the third year, including passing the TXPL 528 course to perform TPW and TXP independently. Generally, a screening appointment precedes the TPW appointment. If the patient’s case is straight forward and time allows, the initial appointment with the patient may include screening procedures, data collection, and a treatment plan presentation. Patient will be assigned to a primary student provider, as well as a secondary student provider for co-therapy at the initial appointment.

    Part I – 1st appointment with patient

    Treatment Plan Work Up (TPW):

    1. Seat patient; Review medical history; Obtain BP and pulse
    2. Get a start from faculty member. Inform the faculty member of any significant medical history and the procedure(s) you plan to perform today.
    3. Review Clinical Data Sheet I. Here is the link to this TPW Calibration Tool http://dentalweb.umaryland.edu/bbtwp/introduction.html. (up-date link) This link gives step-by-step instructions on how to complete data sheets I, II, III and IV and treatment planning form. Collect and enter data into EHR. Radiographs need to be approved and evaluated by faculty. Approvals will be attained for both MiPACS and Axium.
    4. Evaluate Radiographs and obtain assistance to take images of additional radiographs that may be needed.
    5. Obtain diagnostic impressions and bite registration as needed.
    6. Take intraoral pictures when appropriate.
    7. Write any necessary medical consultation if not already completed at screening appointment.

    Part II

    Preparation for Treatment Plan Presentation

    Review and organize all data - systematically arrive at diagnoses, prognoses, contingencies, etc.

    1. Refine your treatment plan primer to be used as an aid for TP presentation.
    2. Use TP primer to record a properly sequenced plan of treatment.
    3. Confirm appointment with patient 24-48 hours in advance.
    4. Cancellations, changes, etc. must be entered in the chart.
    5. Be prepared to discuss alternative treatment plans.

    Part III Treatment Plan Presentation

    1. Have chart, mounted models, radiographs, Oral images, instruments and patient positioned.
    2. Greet and seat patient.
    3. Introduce instructor to patient.
    4. Review medical history; Obtain BP and pulse.
    5. Get a “start” from a Faculty member. Inform the Faculty member of any significant medical history and the procedure(s) you plan to perform today. 
    6. GP Director or Assistant GP Director are the only faculty that are calibrated to cover a TXP.
    7. Present findings in EHR including caries risk assessment, periodontal charting, EOE/IOE, TP Primer, TMD/occlusion, treatment history, medical history, dental history, and other discipline-based forms. Faculty and student will review radiographs, intraoral images, and mounted diagnostic casts. 
    8. Faculty member to examine the patient.
    9. Consultation from specialties as needed.
    10. Finalize treatment plan and obtain an approval swipe of planned treatment from the supervising faculty, which includes the following: see Calibration Tool http://dentalweb.umaryland.edu/bbtwp/introduction.html
    11. Obtain informed consent from patient, which includes having patient sign the treatment plan, followed by the signature of the supervising faculty.
    12. Inform patient of all costs of treatment, and escort patient to the business manager for further discussion of payment options.

    Note:

    Treatment plans must include the patient, student and appropriate faculty consent signatures before treatment services are rendered. Failure to obtain signatures implies there is no informed consent. Since this is such an important issue, such failure will result in an N or a U grade in professionalism for that session. Repeated offenses may result in generation of a counseling report.

    Juniors are required to complete 3 TXPs before they can perform a TXP competency

    Procedure is successful when all parties have signed the treatment plan and the patient has been given a copy of the signed treatment plan that has been entered into Axium.

    Recourse for non-compliance:

    1. Student may receive an N or U grade for both Professionalism and/or the Clinical Procedure on their daily grading form in Axium. An N or U grade in Professionalism will negatively impact their grade in Comprehensive Care and Patient Management 538 and/or 548. 
    2. Academic Counseling Report will be generated that may lead to Dean’s counseling, suspension from clinic, or judicial board review

    UMFDSP Food and Business Meals Expense Policy

    Subject: III. Clinical – H. Patient Administration

    Effective Date: February 1, 2014

    Reviewed and/or Revised: 09/01/2017

    Purpose: To describe and provide some examples of allowable and unallowable business meal reimbursements and food purchases using UMB funds in order to meet:

    1. Maryland General Accounting Division requirements
    2. Internal Revenue Code accountable plan requirements
    3. Federal cost regulations under OMB Circular A-21

    Policy and/or Procedure:

    Section VIII - 99.00 (A) Food and Business Meals Expense

    Functional Area of the VP-In-Charge:

    Administration & Finance

    Contact:

    Disbursements Manager, Financial Services

    410-706-2931

    Required By:

    State of Maryland General Accounting Division Guidelines

    Policy is:

    Revision of A&F Policy 3332

    Policy Statement:

    Expenditures for food must be in accordance with State requirements, reasonable, necessary, and part of a documented bona fide business function of the University of Maryland, Baltimore (UMB). Expenditures must not be for events considered to be routine meetings, gatherings that are primarily social in nature, or purchase of alcoholic beverages. Within these guidelines, the local hosting of an event and purchase of food/catering services or business meals in support of UMB business may be allowable use of UMB funds.

    Department approvers have the right to reject all or part of the reimbursement requests at their discretion.

    Allowable Expenses:

    Using UMB funds to pay for business meals or food/catering services may be appropriate in the following circumstances:

    1. Interviews of an applicant (and the applicant’s spouse, if invited) for employment by official UMB host(s) for positions of Faculty, Department Heads, Directors, Deans, Vice Presidents and President.
    2. Meals with prospective students.
    3. Meals for visiting scholars and faculty.
    4. Meals for distinguished guest speakers/lecturers.
    5. Meetings with business leaders outside UMB for the purpose of developing student interaction, future contributions to programs, or developing business relationships benefitting UMB.
    6. Meetings with colleagues from other universities to discuss university research, instruction, administrative functions, etc.
    7. Business meals where external consultants are participating in official UMB business.
    8. Conferences, convocations, symposiums and other special events which are on behalf of or substantially involve personnel not employed by UMB.
    9. Events where participant fees are collected to offset the food cost (e.g., a conference).
    10. UMB-wide events coordinated through the Office of Communications and Public Affairs to promote or further UMB’s mission (e.g., commemoration of Dr. Martin Luther King Jr. during Black History Month).
    11. Student events and student related functions (note- postdoctoral fellows, residents, and trainees are not students).
    12. Food or meals for activities that are specified as allowable charges under a grant or contract.
    13. Donor cultivation events.
    14. Employee-only full or half-day workshops, seminars, conferences, retreats, etc., where the event overlaps routine meal times.
    15. UMB-wide employee awards/appreciation events coordinated through the Department of Human Resource Services (within UMB University Operations).
    16. Meals during unusual hours or at unusual places of work for employee groups performing required UMB services (e.g. weekend meetings or emergency-related activities).
    17. Meetings with affiliates for three or more hours where the offices of the attendees are more than 5 miles apart.

    Unallowable Expenses:

    Business meals or food/catering services are not appropriate in the following circumstances:

    1. Personal meals among UMB employees.
    2. Routine (see definitions) meetings among UMB employees (e.g. faculty and/or staff meetings).
    3. Meals during general discussion meetings among employees.
    4. Costs associated with social functions or activities such as (but not limited to) birthday parties, holiday parties, retirement parties, Administrative Professional’s Day events, etc.
    5. Expenses for food that are subsequently reimbursed by the UMB Foundation or any affiliated entity.
    6. Purchase of alcoholic beverages (including related tax and tip).
    7. Functions where one or more students are present but the primary purpose of the meeting is not student related.
    8. Other expenses not listed under allowable expenses.

    Dollar Limitation Guidelines:

    The following guidelines are provided to assist faculty and staff in determining what food costs are reasonable within the broad array of events and situations that arise in the course of campus business.

    1. Individuals must apply a prudent and reasonable approach to business meals. The reasonableness of an expense depends upon many relevant factors, including the business purpose of the event and the location. The maximum amount of expense allowable for business and catered meals for one person in one day (including tax and tip) is one and one half (1 ½) times the maximum per diem rate set by the federal government (US General Services Administration). Refreshment or snack expenses are set at the breakfast rate. Click HERE for the current Business Meal Rates.
    2. Departments have the authority to limit or prohibit reimbursement or payments based on availability of funds, availability of lower cost alternatives, specific requirements of funding sources, or reasonableness. Established meal rates are maximums and should not be considered entitlements.
    3. Amounts in excess of these guidelines may be permitted based upon circumstances including location. Expenditures that exceed these guidelines must be justified by the department and approved in writing by the President or his/her designee.

    Applies to:

    All UMB Personnel and Affiliates

    Definitions and Terms:

    Affiliated Entity - An entity that has a relationship with UMB authorized by the Board of Regents or by law, e.g., faculty practice plan organizations, UMB Foundation and other affiliated foundations, recognized incorporated alumni associations, affiliated business entities, the University of Maryland Medical System/University of Maryland Medical Center, and other University System of Maryland institutions.

    Business Meal- A meal, generally occurring off campus, involving one or more non-UMB employees where the business purpose for the expense is clearly identified.

    Employees- Includes all UMB employees (staff, faculty, residents, and postdoctoral fellows; regular, contingent I and contingent II), trainees, and employees of Affiliated Entities.

    Food/Catering Services- The purchase of meals or refreshments served on UMB property or at an off-campus location for a group of people.

    IRS Accountable Plan- An accountable plan is a method for reimbursing employees for business expenses that complies with IRS regulations. If the IRS rules for an accountable plan are maintained, reimbursement paid to employees is not required to be treated as taxable income.

    Routine - In the context of frequency or types of meetings- a meeting is routine when it is regularly scheduled or recurring on a periodic basis (i.e. weekly, bi-weekly, monthly, quarterly, annually, etc.) for the same group of people.

    UMB funds – All funds administered by UMB, regardless of fund source. UMB funds include State Appropriations, Auxiliary funds, Revolving/Discretionary funds, Designated Research Initiative Funds, Contracts or Grants, and Other Restricted funds.

    Scope:

    This policy applies to all food and business meal purchases with UMB funds. The requirements stated in this policy apply when reimbursement or payment is being requested directly from UMB. The policy also applies when reimbursement or payment is being requested from an affiliated entity and subsequently reimbursed by UMB.

    Limitations:

    1. This policy does not apply to food/meal purchases during travel that are covered under UMB Policy VIII-11.00 (A) – UMB Policy on Travel.
    2. This policy does not apply to personal meal purchases related to employee relocations.
    3. This policy does not apply to food that is purchased for resale by UMB (e.g. Donaldson Brown Center).

    Responsibilities:

    The UMB employee responsible for an event or meal involving food cost reimbursement must:

    Submit all appropriate supporting documentation for food purchase or meal reimbursement.

    Ensure that all food purchases and meal reimbursements are appropriate and in compliance with campus policy and Financial Services procedures.

    Obtain appropriate approvals for food or meal reimbursements.

    The Department of Financial Services under the direction of the Chief Administrative and Finance Officer (CAFO) is responsible for establishing procedures to promote compliance with this policy and adhere to IRS accountable plan requirements.

    Employees who improperly submit and approvers who improperly authorize the use of UMB funds may be subject to disciplinary action. Purchases for food using UMB funds that are not in accordance with this policy must be reimbursed to UMB from external funds (e.g., Foundation funds or personal funds).

    Exceptions:

    Exceptions to this policy must be approved in writing by the CAFO. All requests should be in the form of a memo to the CAFO signed by the Dean/Vice President or the Dean/Vice President’s designee (e.g., an appropriate Associate Dean or Associate Vice President).

    Attachments:

    See UMB A&F Financial Services Standard Operating Procedure No. 3332 - Food and Business Meals Expense

    Policy Effective: February 1, 2014

    Verifying Medicaid Eligibility Procedure (Paying for Services: Medicaid (Title 19))

    Subject: III. Clinical – H. Patient Administration

    Reviewed and/or Revised: 09/01/2017

    Purpose: The purpose of this procedure is to assure proper payment for care rendered to individuals who claim Medicaid eligibility

    Policy and/or Procedure

    • Present a valid M.A. card performed by patient
    • Verify and record verification (point to website and telephone number) performed by first contact personnel
    • Check for coverage of planned procedure performed by first contact personnel

    Verifying Patient Account Status Procedure

    Subject: III. Clinical – H. Patient Administration

    Reviewed and/or Revised: 09/01/2017

    Purpose

    The purpose of this procedure is to render care to patients while meeting Dental School revenue goals.

    Policy and/or Procedure

    1. Student reviews AxiUm "Transaction Screen", and "Patient Care" to assure account status: performed by student

    Steps

    • Account no more than 60 days overdue
    • Patient owes no more than $150
    • Patient has paid the cost of care not covered by insurance
    • Grant has not expired (check date)
    • Grant does not exceed cost of care delivered

    Writing a Prescription Procedure

    Subject: III. Clinical – H. Patient Administration

    Effective Date: 9/20/15

    Reviewed and/or Revised: 06/04/2016, 05/25/2017, 09/01/2017

    Purpose: Support Policy Prescription Control System

    Policy and/or Procedure:

    1. Student/resident discusses with faculty need for prescription medication for patient
    2. Credentialed/licensed faculty assesses need for medication
    3. Student/resident informs faculty of what prescription they want to prescribe with name of medication, dose, instructions for taking medication, the # to dispense, the number of refills, and any other notes needed.
    4. Faculty gives verbal authorization to student to create prescription
    5. Student/resident fills out prescription in Axium under medications tab
    6. Faculty review and swipe approval for the prescription to be printed
    7. Student/resident presents printed prescription to credentialed/licensed faculty who read and review the printed prescription.
    8. Credentialed/licensed faculty signs the prescription, using the DEA number for the UMDS
    9. Student/resident hands signed prescription to patient
    10. Student /resident makes an entry on the progress notes in patient record regarding the prescription written
    11. Credentialed faculty swipes approval for progress note entry in patient record

    Writing a Progress Note Procedure

    Subject: III. Clinical – H. Patient Administration

    Department: Clinical Affairs - General Dentistry

    Effective Date: 8/19/13

    Reviewed and/or Revised: 06/04/2016, 05/25/2017, 09/01/2017

    Purpose: Assure content and format of progress note entries in the patient record are consistent across all provider groups

    Policy and/or Procedure:

    1. Locate appropriate screen (see steps 1 thru 11 below) for entry of note: performed by user

    Definitions:

    Axium – School of Dentistry’s electronic patient record system.

    Approval - Approval is needed for the tasks mentioned. Click the Approve button Approve to complete Approval. If the user has forgotten to approve an item, follow the directions below.

    1. The Teal Box on the footer indicates something needs approval. Click the box to see what needs approval. Needs Approval
    2. The user may approve all of the items listed or approve each individually. Click the first Line Item that needs approval.
    3. Click the Approve button. Approve
    4. Also look for the “EPR Forms” on the bottom. If this is still in Blue then something needs approval. EPR Forms

    Notice all text is in Black. Remember the Teal and Blue = Approval Needed.

    Policy and/or Procedure: In order to follow the procedures below, the user must log into Axium with their specific username and password, or swipe card.

    To Enter a General Progress Note

    1. Select a patient.
      1. To search for a patient, click the Rolodex module. Rolodex module
      2. Click in the blank field. Blank Field
      3. Type a Patient's Name (Last, First).
      4. To search for the patient, Press [Enter].
      5. Click the Item Line of your patient. 
        Item Line of Patient
      6. At this point, you have selected your patient. To ensure you have selected your patient, check if the patient’s name and chart number are on the footer bar.
    2. Click the Electronic Health Record module. Electronic Health Record Module
    3. Click the Tx History tab. Tx History Tab-writing a progress Note
    4. To add a Progress Note, click on the Add Note button. Add Note
    5. The selection choice automatically selects General Note. Keep this selected. Click the OK button.
      Select Note Type
    6. Type in the open area to add content. A specific site for the note may be selected, but does NOT need to be selected, and should not be selected for a general progress note.
    7. Click the Add New button. Add New
    8. Faculty may enter progress notes, and then approve themselves. Residents and students must gain approval from faculty after entering a progress note.

    To Enter a Template Progress Note

    1. Select a patient.
      1. To search for a patient, click the Rolodex module. Rolodex module
      2. Click in the blank field. Blank Field
      3. Type a Patient's Name (Last, First).
      4. To search for the patient, Press [Enter].
      5. Click the Item Line of your patient.
        Item Line of Patient
      6. At this point, you have selected your patient. To ensure you have selected your patient, check if the patient’s name and chart number are on the footer bar.
    2. Click the Electronic Health Record module. Electronic Health Record Module
    3. Click the Tx History tab. Tx History Tab-writing a progress Note
    4. To add a Progress Note, click on the Add Note button. Add Note
    5. Select the Template Note by clicking the selection circle.
      Select Note Type-Template Note
    6. Click the OK button.
    7. Click the Code … box to select a template note type. Code Box
    8. Choose a specific template note by double clicking the Line Item Template Note.
      Line Item Template Note
    9. To enter the clinical information, answer the Prompt by typing in the Answer field.
      Answer Propt in Answer Field
    10. Click the Next button.
    11. Continute to answer the prompts until the Next button is grayed out. Then click the OK button.
      After Answering Prompt

    Faculty may enter progress notes, and then approve themselves. Residents and students must gain approval from faculty after entering a progress note.

    2. Assure patient identifying information (full name and Axium number)

    3. Enter tooth number or area being addressed: performed by user

    4. Describe all patient-related events: performed by user

    5. Compose progress note, using either SOAP format (for Oral Maxillofacial Surgery notes) or ATEN format (all other notes)

    6. End entry with identification of supervising faculty.

    7. Supervising faculty approves entry in Axium.