Practitioners Corner
A forum to discuss matters of interest to dental practitioners
Namibian Dental Association
Members Area
Questions recently asked by some colleagues and the answers provided by ExCo members.
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Question:
1. You do a 3-unit PFM bridge for teeth #11-22 (patient is missing #21) How do you charge that?
2. You do a Maryland bridge for teeth #11-22 (patient is missing #21) How do you charge this one?
Assume you have already cut the teeth and the units just came back from the laboratory, ready to be delivered into the patient's mouth.
Answer:
1. You will charge for a three-unit PFM bridge as follow:
During the preparation (cutting) visit:8109x2 (for you and the assistant)8145 (if local anaesthetics are used)8110 (if you provide a wrapped, sterilized tray)When you place the bridge:8411 (PFM crown) for tooth 118424 (Anterior pontic) for tooth 218411 (PFM crown) for tooth 228109x2 (for you and the assistant)8145 (if local anaesthetics are used)8110 (if you provide a wrapped, sterilized tray)8099 (Laboratory fee)Remember that the original laboratory account must be attached to youraccount.2.You will charge for a three-unit Maryland bridge as follow:
During the preparation (cutting) visit:8109x2 (for you and the assistant)8145 (if local anaesthetics are used)8110 (if you provide a wrapped, sterilized tray)When you place the bridge:8356 (Maryland type abutment) for tooth 118424 (Anterior pontic) for tooth 218356 (Maryland type abutment) for tooth 228109x2 (for you and the assistant)8145 (if local anaesthetics are used) 8110 (if you provide a wrapped, sterilized tray)8099 (Laboratory fee)Remember that the original laboratory account must be attached to youraccount.Comment:
Thank you for your interest in asking questions and thus ensuring that you charge correctly! Have a look at the detailed 'Rules and Guidelines' explaining the tariff list. You will find this in the NDA manual provided to you earlier this year. Most of your questions are answered in the guidelines. However, if you struggle or don't find your answers, please keep on asking questions rather than making mistakes!
Question: When you suture a patient and the patient comes back to remove the sutures, you don't have to charge code 8104, do you? just 8110, 8109 x2, right?
Answer: Removal of sutures placed as part of a surgical procedure will be considered by most practitioners as part and parcel of the surgical procedure and no charge will be levied for the removal of the sutures.
Treatment code 8104 is charged when a patient is consulted for a new specific problem, not forming part of your current treatment plan. Since removal of sutures is not a new problem, you are correct in saying that you should not charge 8104 in this case.
Although most practitioners remove sutures free of charge, it will be acceptable to charge 8110 and 8109 if this sterile tray and infection control are actually supplied.
Question: When I consult a new patient and proceed to make a new full upper and lower denture, I charge 8101 for the first visit and 8104 for each subsequent visit when I do the second impressions, bite, try-in etc. Is this correct?
Answer: No. If you consult a new patient, do a complete examination of the oral cavity, all soft and hard tissues (if any), compile and discuss a treatment plan and costs with the patient, even in an edentulous patient, it will be correct to charge 8101 for the first visit. However, for the subsequent visits, bite, try-in etc., it is wrong to charge 8104 since these visits do not address a new specific problem. These visits are merely a continuation of your current treatment plan.
Question: How often can I do scaling and polishing for a patient? Can this be charged more often than once in six months?
Answer: It is accepted norm that dental patients are seen once every six months for a routine examination and preventative treatment. This will often include scaling and polishing and the norm is to charge a patient for this not more often than once in six months.
However, periodontally compromised patients or patients with a particular need for more regular preventative care, might necessitate scaling and polishing more often. In such a case it would be acceptable to charge a patient for this more often than once in six months. (e.g. once in three months might be needed). In such cases the presence of supra- and/or sub-gingival calculus will determine whether this procedure is justifiable more often than once in six months.
Question: If I remove a fixed bridge, to enable me to extract a decayed anchor tooth, and decide to make the new fixed bridge only once the extraction wound has healed (e.g. in eight weeks time), may I make and charge a temporary bridge during the period of healing?
Answer: Yes, that would be acceptable.
The NDA National Schedule of Recommended Fees and Guidelines defines a temporary crown (or bridge) as follow: Crown/bridge utilized as an interim restoration of at least six weeks during restorative treatment to allow adequate time for healing or completion of other procedures. This includes, but is not limited to, changing vertical dimension, completing periodontal therapy or cracked tooth syndrome. This is not to be used as a temporary crown/bridge for a routine prosthodontic restoration.
A temporary crown/bridge is thus placed, and charged, to enable us to complete pre-prosthodontic treatment and is done before the final crown/bridge preparation and before final impressions are taken. The temporary crowns/bridges placed as part of routine prosthodontic treatment (i.e. while the final restoration is manufactured by the technician) is part and parcel of the prosthodontic treatment and is not charged separately.
A general practitioner dentist will charge for a temporary crown/bridge, under the circumstances described above, by using treatment code 8137. There is no fee for a temporary pontic.
Question: Please help, what is the code used to charge for the assistant’s fee if we (two dentists) assist each other in theater? Can you also claim assistant’s fees when you treat a patient in the dental surgery? What if my regular dental assistant is on sick leave and my associate or another dentist assists me in the dental surgery?
Answer: A short summary of the rules that apply for charging assistant’s fees:
- Assistant’s fees are only charged when the practitioner is assisted by another professionally qualified practitioner, i.e. another dentist.
- Assistant’s fees are only applicable to treatment codes listed under Maxillo-Facial and Oral Surgery (Section J of the NDA National Schedule of Recommended Fees and Guidelines)
- The treatment code to use is 8007 and the fee is calculated as 15% of the fee/benefit of the practitioner performing the operation, with the indicated minimum (see Modifier 8007) of N$ 345.00 (NDA fee) and N$ 136.90 (NAMAF fee).
- The patient must be informed beforehand that another dentist will be assisting at the operation and that a fee/benefit will be payable to the assistant.
- The assistant's name must appear on the invoice rendered to the patient.
- Whether the patient is treated in an operating theatre or in the dental surgery is not relevant and does not influence the application of the above rules.
Please read the rules on pages 5 & 6 of the NDA NATIONAL SCHEDULE OF RECOMMENDED FEES AND GUIDELINES carefully. All is explained in detail on these pages.
Question: If I place a screw-retained crown on an osseo-integrated implant, do I charge for the occlusal filling to cover the screw or not?
Answer: Yes, the rules allow you to charge either treatment code 8351 or 8367 plus 8346, whichever is applicable.
Most practitioners however reason that placing a screw-retained crown without closing the access hole would be an incomplete procedure. They therefore take the position that if a new crown is placed, closing the access hole should be part of the procedure and should not be charged extra. If an existing crown is removed for inspection or maintenance and subsequently replaced, the filling to cover the screw is charged as a separate entity.
Question: I am considering the use conscious sedation to facilitate treatment of anxious patients. Do I need any additional training or equipment to do this? What do I have to be aware of?
Answer: Conscious sedation as an aid in treating dental patients is an accepted practice and can be of great value in treating anxious patients. However, the NDA Executive Committee would urge members of the NDA to take cognisance of the many pitfalls and potential dangers of sedating patients if not done correctly and safely.
Since there are no specific guidelines available on conscious sedation for dental patients in Namibia, it was decided to approach the South African Dental Association (SADA) in this regard. The decision to approach SADA, and the reaction received from them, was based on the need for regional co-operation and conformity as recommended by the African Regional Organisation (ARO) of the FDI. Furthermore, consideration was given to the fact that SADA acts as membership-hub and administrator for Dental Protection Limited (DPL), the organisation providing professional indemnity insurance to most NDA members.
Published on this website you will find the document: The South African Dental Association – Guidelines on Conscious Sedation. The NDA Executive strongly recommends that you study this document and adhere to these guidelines, should you consider to practice conscious sedation in your practice.
Should any questions or enquiries arise regarding the use of conscious sedation by dentists in Namibia, the Ethical Committee of the NDA will use the mentioned guidelines as an aid in considering any such questions or enquiries.
Click here to view the mentioned document: The South African Dental Association – Guidelines on Conscious Sedation.
