An insightful and informative newsletter from the Art of Practice Management. A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.

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Do you ever wonder why, in the same day, you are hit by the same message twice?
That's what happened to me this week through email. Both emails dealt with a topic
that I have written about before but seeing the message twice made me realize that I
should address this important topic one more time. The first email was the February
27th issue of The ADA Morning Huddle in an article titled "Study: Dentist's Office May
Be Good Place for Diabetes Screenings" which I had postponed reading until that day.
The second email came a short while later when I listened to this week's Wednesday
Watch titled "Diabetes Detection at the Dentist". The message I took from these two
emails – this must be important, share it!
The topic of both was that a study was done at NYU where adults with or at risk for
diabetes were screened for diabetes in a dental setting. The method for this study
involved performing hemoglobin A1c (HbA1c) tests on dried blood samples of gingival
crevicular blood and comparing these with paired "gold-standard" HbA1c tests with
dried finger-stick blood samples. They examined differences in sociodemographics
and diabetes-related risk and health care characteristics for 3 groups of at-risk
patients.
The result of these screenings was that "about half of the study sample had elevated
HbA1c values in the combined prediabetes and diabetes ranges, with approximately
one fourth of those in the diabetes range. With a correlation of 0.991 between gingival
crevicular and finger-stick blood HbA1c, measures of concurrence between the tests
were extremely high for both elevated HbA1c and diabetes-range HbA1c levels."
The conclusion drawn from this is that gingival crevicular blood collected during a
dental visit can be a reliable screen for diabetes and can monitor glycemic control for
many of our at-risk patients. "Persons already diagnosed with diabetes and
undiagnosed persons aged 45 years or older could especially benefit from HbA1c
testing at dental visits."1
Dental practices that cross code to medical can take this one step further and can
submit claims to medical carriers for the screenings. The coding is as follows:
 CPT code – Due to the fact that this blood sample collection is not a collection
of venous blood by venipuncture and because the cost of collecting this
specimen is minimal, the CPT code 36415 (which is used for venous blood by
venipuncture) should not be used. This blood collection should be considered
as part of the evaluation and management service and coded accordingly.
 ICD-9 code V77.1 – use this code if the patient has not been diagnosed with
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diabetes. If the patient has been diagnosed with diabetes, contact his or her
primary care provider to obtain that patient's code.
As of date of service Oct. 1, 2015 and after (provided ICD-10 is implemented
on that date), use:
ICD-10 code Z13.1
Cutting edge dental practices that are looking for ways to address their patients'
overall body health should incorporate diabetes screening into their procedure mix. It
can obviously result in better patient health but also better practice health through
increased revenue.
1
American Journal of Public Health, The Potential for Glycemic Control Monitoring and
Screening for Diabetes at Dental Visits Using Oral Blood,
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302357?journalCode=ajph,
March 14, 2015
Also:
Dentistry Today, "Wednesday Watch", https://www.youtube.com/watch?v=Y8qRnN5-sLM,
March 14, 2015
WaterFlosser and the Research
Colleen Rutledge, RDH
In order to recommend a product, you have to know the research. I often recommend
Waterpik products to my patients and consulting clients. It's amazing to me that the
technology is actually 53 years old and supported by 60 clinical trials. Evidence shows
that using a WaterFlosser is both safe and effective. (1) This is based on many years
of use by the public and with no reported adverse effects.
I am often asked what power setting is best. Regarding the
Ulta (retail model, pictured) / Aquarius (in-office model), I
recommend starting at "1" and work up to "5". Patients
sometimes ask if the pressure of the pulsating water will push
bacteria into the pocket at higher settings. There is no
evidence to support the assumption that a pulsating stream of
water negatively impacts the junctional epithelium. (2)
However, not all oral irrigators have the same specifications and research as Waterpik
products. That's why I'd like to direct you to an article written by Dr. David Jolkovsky
and Deborah Lyle RDH, BS, MS on the safety of the Water Flosser. It is available
online in Compendium, so check it out:
http://www.dentalaegis.com/cced/2015/02/safety-of-a-water-flosser-a-literature-review
1. Goyal CR, Lyle, DM, Qaqish JG, Schuller R. Evaluation of the plaque removal efficacy
of a water flosser compared to string floss in adults after a single use. J Clin Dent.
2013;24(2):37-42.
2. Al-Mubarak S, Ciancio S, Aljada A et al. Comparative evaluation of adjunctive oral
irrigation in diabetics. J Clin Periodontol. 2002;29(4):295-300.
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3. Dental – Do you get frustrated when a crown is downgraded to a filling (alternative
benefit). Are your patients unhappy about this also? You can implement ways to
decrease the likelihood of this happening. Insurance carriers require that either a
cusp be missing or three or more surfaces be involved before benefits will be paid
on a crown. Therefore, documentation of this information is a must. Narrative
information on the claim to support this should be included. Photos are also
important.
Medical – Are you preparing? October 1, 2015 is not far off. That is the proposed date
for ICD-10 implementation. If you aren't sure what you need to be doing to prepare,
please check with me. I am available to help with ICD-10 implementation. Also, I will
be the speaker for an AudioEducator audio conference on June 23, 2015 that will
have ICD-10 implementation for dental practices as the topic.
January 1, 2015 – The updated cross coding is now available with the codes for
2015 in addition to instructions on completing the new medical claim form. Please go
to the following link to order your update: 2015 Code Update
January 1, 2015 – Updated CDT codes. If you haven't already purchased your CDT
manual, please do so ASAP. My recommendation is Coding with Confidence.
Coding with Confidence/Practice Booster Order Form.
June 1, 2015 – All physicians and eligible professionals, including dentists, who treat
Medicare beneficiaries and write prescriptions for these patients must either enroll in
the Medicare program or opt out of it. Delaying your decision can be very
problematic.
October 1, 2015 – The beginning date for ICD-10 implementation.
 March 20, 2015 - Los Angeles, CA - Register now
 April 17, 2015 - Houston, TX - Register now
 May 8, 2015 - Seattle, WA
 June 5, 2015 - Dallas, TX
 July 17, 2015 - San Francisco, CA
 August 14, 2015 - Atlanta, GA
 September 25, 2015 - New York, NY
 October 9, 2015 - Schaumburg, IL
 November 6, 2015 - Los Angeles, CA
Time Line
Insurance Alert
Marianne's Seminar Schedule for Dental Medical Billing
101 with ICD-10

4.  April 17, 2015 - Rockville, MD
To register: 443-691-4008 or jillian.mo3@gmail.com
 April 24, 2015 - Suffern, NY
To register: 707-769-8887 or Register online
 April 25, 2015 - Hershey, PA
To register: 707-769-8887 or Register online
 October 16, 2015 - Charlotte, NC
To register: 707-769-8887 or Register online
 October 17, 2015 - Raleigh, NC
To register: 707-769-8887 or Register online
 November 6, 2015 - Allentown, PA
To register: 707-769-8887 or Register online
 November 7, 2015 - Tinton Falls, NJ
To register: 707-769-8887 or Register online
Favorite Quotes:
"If you aim at nothing, you will hit it every time."
~ Zig Ziglarbgh
Tips:
As stated in my article above, I was moved by the two similar emails that I received
on the same day and felt led to share. Well there actually was a third that same day
that also impacted me, so now I must share again. If you remember, the Tips article
in the January 2015 newsletter dealt with warning our patients about enamel erosion
due to hidden acids in food and drinks and this email article expanded upon the
types of food and drinks that are acidic and that damage enamel. I am a salad lover
and when I saw the words balsamic vinegar I was taken aback because I hadn't
even thought of that as a danger. I also love fruit and it mentioned berries, citrus fruit
and dried fruit. It's easy to not think of our favorite foods and drinks as being
problematic but please also share this information with your patients.
Points of Interest:
And here I go again with a fourth email – you are wondering if all I do is
read emails, aren't you? Click on this link and you will see what caught
my eye. http://www.youtube.com/watch?v=yeaztQK9If0 I then took a peek
online to see about lions and dentistry and found out the following.
Peruvian circus lions are often mistreated dentally. The circus owners
often break a lion's teeth and no anesthesia is used because the circus
owners are not veterinarians.
An organization titled Animal Defenders International has stepped in and is treating
some of these lions' dental issues. They have rescued 60 lions and these lions are
being transferred to sanctuaries.
The DoDo, Dramatic Images Show Ex-Circus Lions Getting Much Needed Dental
Work, https://www.thedodo.com/lion-dentist-oral-surgery-adi-1014653509.html,
March 14, 2015
Colleen's Seminar Schedule for 2015

5. Is there someone you think would be interested in this newsletter?
Please feel free to forward this email to them. Thank you!
The Art of Practice Management
2217 Fox Horn Road • New Bern, NC 28562 • Phone: 1-252-637-6259
www.artofpracticemanagement.com • a.p.m.1@suddenlink.net
Perio-Therapeutics & Beyond
724 Fitzwatertown Road • Glenside, PA 19038 • Phone: 267-241-5833
www.perioandbeyond.com • colleen@perioandbeyond.com
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About us | Privacy policy | © Copyright 2015 - Marianne Harper
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