Our Approach to Care
Ideally, we hope to see our maternal patients 4x in OB and 2x in Dental:
- First visit: screening/assessment, education, saliva test, referral
- Patient should see Dentist between 1st and 2nd Trimester (OB) visits
- Second visit: prophylaxis and education
- Third visit: education
- Fourth visit: education and saliva test
- Patient should see Dentist after baby is born (>6 mos after 1st Dental visit)
Initial State: Before our project began, one site was typically not providing prophylaxis at all (their focus was education and getting patients the care they needed in the dental clinic) while another site was performing prophylaxis during the first visit.
Improvements and Standard Work: Site “A” decided to begin providing prophylaxis for patients in conjunction with their OB appointments during the second visit. Site “B” decided to move the prophylaxis from the first to the second visit.
During the first visit, patients get ultrasound with OB provider so patient’s already been in clinic for > 1 hour (prior to oral care). RDH cares for patient about 15-20 minutes + saliva test, adding 15 min (30 min total) putting patient about 2 hrs total for first visit not including hour (or more) prophy. The prophy should be completed at 2nd visit in OB clinic.
Available Prenatal Care for Mothers
One component of this project is to deliver care to patients. The registered dental hygienist practicing under a PA161 program can provide the following services:
- D0191 Assessment Of A Patient ($14.89)
- D1110 Dental Prophylaxis Adult
- 0 to 19 years: ($27.72)
- 19 to 124 years: ($22.10)
- D1120 Dental Prophylaxis Child ($19.53)
- D1206 Topical Fluoride Varnish
- 0 to 3 years: ($9.00)
- 3 to 16 years: ($13.23)
- D1208 Topical App Fluorid Ex Vrnsh ($13.23)
- This means “Topical fluoride that is not varnish”
- D1330 Patient Education (not billable)
Care for Children
Most mothers will take their children to the pediatrician for well-child checkups at 9 months, 12 months, 18 months, 2 years, and 3 years. Children can receive the following services from their pediatrician at those visits:
- Patient Education (not billable)
- D0190 Oral Health Assessment ($14.89)
- 99188 Application of dental fluoride varnish ($9.00)
- Referral to a dentist (not billable)
These services are performed by a medical professional in a pediatrician’s office and are billed under the medical billing system. The reimbursement rate for the “D Code” is retrieved from the MI DHHS Dental Fee Schedule (Jan – 2017). Even though it is a “Dental Code,” it is stilled billed through medical. The reimbursement rate for the 99188 CPT Code is retrieved from the AAP State Medicaid Payment for Caries Prevention Services by Non-Dental Professionals (Last Updated June 2013). The latest instruction for medical providers and physicians came from a December 2017 MI-DHHS bulletin (click here).
Within the PA161 program, these services are billed through dental. The reimbursement rates are retrieved from the Michigan Department of Health and Human Services Dental Fee Schedule (January – 2017).
Some clinics may also have dental codes including:
- D1310 Nutritional Counseling (not billable)
- D1320 Tobacco Counseling (maybe billable)
- D1351 Dental Sealant Per Tooth ($15.12)
- Sealants benefit newly erupted teeth mostly because newly erupted teeth are at highest risk of decay, especially where sealants are placed. Provide sealants any time it benefits a patient or on request. While sealants can be given to any patient (PRN), Medicaid won’t cover it and private insurance may not insure sealants or may provide limited reimbursement or coverage. Yes, adults could get them, but chances are it will be hard to find teeth to seal in the adult population that aren’t already decayed, missing, filled, or crowned. The most likely patient, if any, to receive sealants through MIOH are very young mothers. MIOH hygienists can provide sealants to any children in the family, if needed. Sealants are only covered (by Medicaid) for children aged 6-9 (first molars) and 9-12 (2nd molars).
- D4355 Full Mouth Debridement ($43.26 but not part of PA161)
- D4910 Periodontal maintenance service (maybe billable)
- We are currently reviewing the D4346 code.
FAQ
Here are some questions that our hygienists have asked and the answers might also help you!
Q: Will sites get any posters/visual aids for patient educational purposes?
Yes! We are working on these things as of early 2018 and plan to convey them to you soon. Program promotion and patient education are main components of the project. Please be patient with us as we work toward creating appropriate and effective tools! In the meantime, make sure to focus on the education provided through the research component of the project.
Q: Will sites be receiving any more equipment, i.e. the stuff listed during training?
Our budget allotted money for equipment and supplies including deliveries. The largest expenditures on that line item are the chairs and carts for all sites. That stuff (chairs and carts) should be in place and settled by the end-of-December 2017 budget cycle at which time we’ll have a clearer picture how much money is left in that budget line item for any other supplies. It will be very close so we don’t have a lot of wiggle room and need to wait until the dust settles to see how much we have left to spend before we purchase things on that line item. We wish that equipment was in place by now. But, we’re making the best out of this budget and will keep working toward this and keep you posted. Balancing the budget is the least fun part of the project…
Will Detroit Mercy mail us some research consent and screening forms?
Yes! As soon as we complete the revisions, after having received wonderful feedback from many hygienists at our pilot sites, we will mail those out!
Can you explain the “Care for Family” section of the screening form?
Sure! Let’s look at an example: “# D0191 Assessment (Child).” Hygienists are welcome to provide and document care for any children/siblings who might attend a pre-natal visit with mom. If there is a single child who receives this service during mom’s visit, the hygienist would mark a “1” in that row to indicate “1” oral assessment was provided to child on that date during that visit. Or, if the hygienist provides care to 2 children on that date/visit, the hygienist would indicate “2” on the row. You can provide care at more than one visit, e.g. during the 1st and post-natal visits, for the children who come with mom. Don’t forget to document everything in the EDR, too!
Is the assessment form used for multiple visits?
It can be. Or, a new form can be used as long as the hygienist properly records the SCM Research number. Hygienists can record visit date(s) in the leftmost column on the bottom section of the form.
Do you have a tool that can help me forecast dates?
We sure do! Our friends at Grace Health recommend using a “Due Date Wheel” and we found one available from the March of Dimes if you want to purchase one from a reliable source (click here).
Who do we call for equipment (chair, cart) repairs?
Great question! Please refer to the Aseptico website (click here) for contact information regarding service for your mobile cart. Mitch Fowler is our sales rep.
This afternoon, I educated a group of moms at centering. Most of them had already had their cleaning, but it was also prior to the research project so they have not had their saliva tested. Would you still like their educational visits tracked?
Yes! We are currently working with the hygienists to see if this would be best done: (1) using the research online survey and marking no saliva test or (2) using a dummy code to track the education intervention.
When a patient comes in that the hygienist has already seen and already done a screening with (before the project started), does the hygienist need to start a new tracking sheet even though its not the initial screening appointment?
Yes! Also, please do a saliva test during that first patient interaction. How you complete the form is up to you, meaning: you can “backdate” the prior care on the tracking sheet to inform your care moving forward or you can omit that information from the tracking sheet (because it is probably kept already in your dental records and predates the project). How you use the form is up to you but, yes, please start a new tracking sheet for every single patient during every single first visit!