Documentation
What are the 6 questions of Documentation that one should attempt to answer for each encounter?
Who, What When, Where, Why, and How
What type of exam is a D0140 - limited oral evaluation?
Problem -focused
What is used to support allegations of fraud, abuse, or malpractice?
Weak or missing documentation
Which translation service is IUSD contracted with?
Language Line
What do radiographs support in the medical record?
Medical Necessity
What is considered "timely and reasonable" for documenting and approving your chart entries?
24-48 hours
Which type of exam for a new or established patient MUST include an examination for Oral Cancer in order to be billed?
D0150 - Comprehensive Oral Exam - new or established patient
__________ is one example of Fraud?
True or False? Family members are allowed to translate for the patient.
False!
ONLY IUSD certified translators may be used in place of Language Line Services
Which animal has the same number of teeth (32) as an adult human?
A giraffe
What is the most common audit finding when charts are reviewed?
Inadequate supporting documentation
D0140 is reported when... (name one)
Trauma
Acute Infection
Emergency
Referred for a specific problem by another provider
Once a provider has been made aware of “Abuse” but doesn’t correct the error while ignoring the potential consequences, he or she then crosses the line into _______________ and the violation of abuse can then elevate to Fraud.
Reckless Disregard
D4910 Periodontal Maintenance routinely follows a Comprehensive Oral Evaluation
False!
D4910 routinely follows Scaling and Root Planing (SRP)
D4341 SRP - 4 or more teeth, per quadrant
D4342 SRP - 1-3 teeth, per quadrant
Who is the elf in Rudolph the Red Nosed Reindeer that wants to be a dentist?
Hermy the Elf
What can happen if you use unrecognized abbreviations, symbols, acronyms, or misspelled words in your charting?
Harm or unfavorable outcomes to the patient
What type of evaluation is done to determine an established patient's oral health status since their last check-up?
D0120 periodic oral evaluation - established patient
_________ states that over-coding and under-coding are equal and clear violations.
False Claims Act
Scaling is the definitive procedure during a scaling and root planing (SRP)
False! Root planing is the definitive procedure.
Document the specific teeth that were root planed to support SRP code set nomenclature in order to appropriately bill this service
What type of radiograph allows for a comprehensive all-in-one view of the oral structures to be seen?
D0330 - Panoramic radiograph
What must be proven in your documentation and drives the need for services rendered for each encounter?
Medical Necessity
Which CDT code is used to report a re-evaluation - post-operative office visit?
D0171
What type of document is a dental record?
The dental record is a legal document
"If it isn't documented, it didn't happen"
2 periapical (PA) radiographs taken of #21 and #22 would be coded as:
D0220 intraoral - PA first radiographic image #21
D0220 intraoral - PA first radiographic image #22
False! Correct coding is:
D0220 intraoral - PA first radiographic image #21
D0230 intraoral - PA each additional radiographic image #22
This animated dentist is known as Nemo's captor in "Finding Nemo"
Dr. P. Sherman