How do you understand the Procedure Code Setup screen?

Description *

The description that appears on a patient’s ledger and all reports. Generally, this is the current ADA Code description. For user-defined codes, it is a meaningful description associated with the user-defined code.

Code *

The code that appears on all fee schedules, a patient’s ledger, and all reports. Generally, this is the current ADA Code, or “D” code. The user can define additional codes for items not listed in the current ADA Code, generally indicated as a “Z” code. Examples of “Z” codes are retail items (toothbrushes, toothpaste, mouthrinse) or non-retail items (appointments for delivery of bleaching trays, delivery of crowns, try-in of prosthodontics).

ADA Category

Category defined by the current ADA Code

User Code

A shorthand version of the Description as defined by the user. For example, “D2330 – Resin-Based Composite – One Surface, Anterior” could be defined as “resin1”. When inputting treatment, the user would be able to enter “resin1” in the User Code field to place “D2330 – Resin-Based Composite – One Surface, Anterior” in the patient’s record.

Other code

Designed for Medicaid codes or other such code that a particular insurance carrier requires on claim forms. If a code is indicated in this field, this code would print on the insurance claim form rather than the ADA code. However, recently Medicaid has determined the ADA code is acceptable for claims.

Recall

For procedures that should be placed on the recall list, indicate the generally accepted recall interval for the procedure.

NOTE – the recall interval can be changed for an individual patient without affecting the interval for the entire office database. For example, the generally accepted recall interval for prophylaxis procedures (D1110 through D1205) is six months. However, the provider wishes to have the interval for patient John Doe changed to three months. The interval can be changed on John Doe’s recall screen without affecting the entire office population.

Procedure Type *

Defined as “Dental” or “Medical”

Procedure Time

This setting reflects a user-defined length of time generally allowed each procedure. It indicates the most often used length of time. Scheduler units of time are defined in the Offices section of the Setup. This field is helpful to ensure an appointment in the Scheduler is allowed adequate time for the procedure(s) selected.

For example, in an office that utilizes 15 minute intervals, “D2330 – Resin-Based Composite – One Surface, Anterior” could be indicated as normally requiring 45 minutes. If a user makes an appointment for only 30 minutes, the Scheduler will prompt with an inquiry to accept or decline a time adjustment in the Scheduler for the appointment. If accepted, the appointment would increase to a 45 minute duration. If declined, the appointment would remain as 30 minutes.

Time Pattern

For each unit of time, a pattern of time can be defined that shows the requirement for a dentist practitioner for the procedure, and is indicated as Xs (x), slashes (/), or periods (.). The time pattern assists in determining the length of time an appointment requires when a procedure is entered in an appointment on the Scheduler’s Add/Edit screen. It will also indicate in the left column of the Scheduler screen when a provider is and isn’t available for booking. Scheduler units of time are defined in the Offices section of the Setup.

An “x” indicates a provider could be double booked in different operatories without the Scheduler determining the provider is not available. The “x” indicates time in which a dental assistant is monitoring and/or working with the patient (i.e., taking x-rays). Therefore, the provider is not indicated as required in the operatory for the designated length of time for the procedure.

 A “’/” identifies time in which the provider is required and cannot be in booked in another operatory.

A “.” designates anesthesia time in which the doctor does not have to be physically present in the operatory. During this time, the patient is achieving numbness from local anesthesia.

For example, in an office that utilizes 15 minute intervals and the procedure is marked for 60 minutes total, “D2330 – Resin-Based Composite – One Surface, Anterior” could be indicated as “x.//” This designation indicates the first 15 minutes are dental assistant time, the second 15 minutes are for anesthesia, and the final two segments of 15 minutes each are provider time in which the provider cannot be in another operatory.

Production Type

Procedures can be user defined as None, Low, Medium, or High productivity.

Insurance Category *

The Insurance Category generally mimics the ADA Category.

Insurance Billing Order

The order in which the procedure should be claimed to dental and medical insurance companies.

Chart Category

Each procedure is defined as Restorative, Bridge, Extraction, Root Canal, and so forth in the charting module.

NOTE – these categories are predefined by the program and it is suggested they remain as defined. The designations instruct the charting module to properly draw the procedure selected.

Tooth Area

An applicable portion of the tooth can be defined for drawing In the charting module. For example, “D2790 – Crown – Full Cast High Noble Metal” should have the “Crown” selection chosen. Another example, “D2330 – Resin-Based Composite – One Surface, Anterior” should have “Surfaces” chosen.

NOTE – these categories are predefined by the program and it is suggested they remain as defined. The designations instruct the charting module to properly draw the procedure selected.

Draw Chart As

A procedure can define a particular image for drawing In the charting module. For example, “D7111 – Extraction, Coronal Remnants – Deciduous Tooth” should have the “Missing Tooth” selection chosen. Another example, “D6240 – Pontic – Porcelain Fused to High Noble Metal” should have “Bridge Pontic” chosen.

NOTE – these categories are predefined by the program and it is suggested they remain as defined. The designations instruct the charting module to properly draw the procedure selected.

Active

Allows the ability to turn off a code without having to access each office’s Procedure Codes settings. This feature is especially helpful for multi-location offices. It allows an individual code to be “turned off” with a single entry rather than having to access each location’s Setup/Office information to deselect the code from office usage in Treatment Plans and Transaction Entry.

Dentist Limited

If the procedure is restricted to be performed only by the dentist practitioner, the box should be checked. If the procedure can be performed by a hygienist, an assistant, or other staff member, the box should not be checked.

Taxable

If the procedure is taxable by the office’s state sales tax law, the box should be checked. If the office is not required to collect sales tax on the procedure, the box should not be checked.

Sales Tax Code

If the procedure code should appear on an insurance claim form for reimbursement by an insurance carrier, the box should be checked. If the procedure code should not appear on an insurance claim form for reimbursement by an insurance carrier, the box should not be checked.

Requires Lab

If the procedure requires submission to a lab and needs to be tracked by the office, the box should be checked. If the procedure does not require submission to a lab nor needs to be tracked by the office, the box should not be checked.

Ortho Procedure

If the procedure is an orthodontic and needs to be reported as an orthodontic treatment, the box should be checked. If the procedure is not an orthodontic procedure, the box should not be checked.

Visit Code

If the procedure should be tracked by the office as a patient visit, the box should be checked. If the procedure does not need to be tracked as a patient visit, the box should not be checked.

Ledger Code

If the procedure should be accounted on the patient ledger, the box should be checked. This will allow the procedure to be posted to the ledger. If the procedure does not need to be accounted on the patient ledger, the box should not be checked.

A/R Code

If the procedure should be included on the Accounts Receivable reports, the box should be checked. Please note if a code is marked a ledger code but NOT an A/R code, the code will be posted to the ledger with zero fees, regardless of fee schedule attached. If the procedure does not need to be included on the Accounts Receivable reports, the box should not be checked.

Post-Op

If the procedure should be reported as needing a post-operative follow-up for the patient visit, the box should be checked. If the procedure does not need to be reported as needing a post-operative follow-up for the patient visit, the box should not be checked.

Requires Tooth #

If the procedure requires a tooth number, the box should be checked. If the procedure does not require a tooth number, the box should not be checked. Restorations and extractions are examples of procedures that usually require the reporting of tooth numbers. Generally, if a surface is required, the tooth number is also required. For example, “D7111– Extraction, Coronal Remnants – Deciduous Tooth” requires a deciduous tooth number to be reported.

Requires Surface

If the procedure requires the tooth surfaces to be reported, the box should be checked. If the procedure does not require the tooth surfaces to be reported, the box should not be checked. Restorations often require the reporting of the surfaces. For example, “D2332 – Resin-Based Composite – Three Surfaces, Anterior” requires the reporting of three surfaces on which the procedure is performed.

Requires Quadrant

Some procedures (i.e., D4341– Periodontal Scaling and Root Planing – Four or More Teeth Per Quadrant) require reporting of the quadrant in which the treatment is performed. If the procedure requires the mouth quadrant to be reported, the box should be checked. If the procedure does not require the mouth quadrant to be reported, the box should not be checked.

Min. No. of Surf. Reqd.

Many procedures that require surfaces to be reported are specifically limited by the ADA Code to the amount of surfaces allowed. For example, “D2330 – Resin-Based Composite – One Surface, Anterior” is limited to one (1) surface on an anterior tooth. Therefore, the “Min. No. of Surf. Reqd.” field should be “1”. Another example, the field for “D2393–Resin-Based Composite –Three Surfaces, Posterior” should be indicated as “3”.

Max. No. Of Surf. Reqd.

No capitalization of “of”

Some procedures that require surfaces according to the ADA Code can be reported as having more surfaces than the description text states. For example, the field for “D2394 – Resin-Based Composite – Four or More Surfaces, Posterior” should be indicated as “6”; that is, the maximum number of surfaces of a tooth. However, “D2330 – Resin-Based Composite – One Surface, Anterior” is limited to one (1) surface on an anterior tooth. Therefore, the “Max. No. of Surf. Reqd.” field should be “1”.

Select Tooth Numbers

A visual indication of which tooth numbers are valid for the procedure.

Select By Region

A quick way to select valid tooth numbers. By selecting “Anterior – Permanent,” the boxes for teeth 6 through 11 and 22 through 27 will be indicated with check marks.

Select All

If the box is checked, all teeth will be indicated as valid for the procedure. An example of a procedure that should have the Select All box checked is “D2140 – Amalgam – One Surface, Primary or Permanent”.

Select Permanent

If the box is checked, only the permanent dentition will be selected as valid for the procedure. “D8090 – Comprehensive Orthodontic Treatment of the Adult Dentition” is an example of a procedure that should have the box checked.

Select Primary

If the box is checked, only the primary (deciduous) teeth will be selected as valid for the procedure. For example, the ADA Code of “D7111 – Extraction, Coronal Remnants – Deciduous Tooth” should have this box checked.