By Theresa Sheppard, RDA
It is Friday afternoon. One of the chairside assistants called in sick this morning, so the remainder of the clinical team works together to pick up the slack. The dentist is stuck in an operatory surgically removing the root tips of what was expected to be a simple extraction, while your crown prep that has already been waiting for a while just announces to you that they have to leave to pick up a child in an hour. The handpiece in the hygiene room quit working all of a sudden, so the hygienist had to move her patient to another operatory to polish. There are instruments piling up, and lab cases still need to be sent out. Will this day ever end?
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The extraction is finally finished, and the hygienist just dismissed her patient. Just when the remaining assistants were starting to see a little light at the end of the tunnel, the receptionist comes in the back to tell them that there is an emergency patient coming in. When the assistants ask her what the patient’s emergency is, she says, “I don’t know exactly; he just said that one of his back teeth was killing him.”
The assistants turn back to their mounting pile of instruments as their blood pressure goes sky high. Nevertheless, they take a deep breath and start to gather the necessary items to see this emergency addition to the schedule.
The patient arrives, and the receptionist tells the patient that since he hasn’t been seen for over two years that he need to fill out new paperwork. Finally, the patient is ready and the assistant seats him as soon as operatory becomes available. During triage, the patient states he has been in pain for a couple of weeks but has been swollen for only two or three days. He said that since the weekend was coming he thought he should get in. In reviewing his treatment plan, the assistant discovers that he has been non-compliant with the root canal treatment he was advised he needed on his last visit. The dentist views the X-rays and prescribes an antibiotic and pain medication, and instructs the patient to schedule for the root canal the following week.
The assistant escorts the patient to the front and tells the receptionist that the patient needs to schedule for the endo and that the “Doctor didn’t do anything today.”
The receptionist attempts to collect the patient’s co-pay for an office visit, but the patient argues that he shouldn’t have to pay because the “Doctor didn’t do anything.” Now, the front office is stuck dealing with a sticky situation. Sound familiar?
“The Doctor didn’t do anything.” I cringe every time I hear a team member say that! To begin with, this patient was an emergency call late in the day and was worked in an already busy schedule. Therefore, there was a disruption of the dentist’s time reserved for treatment on regularly scheduled patients. There was a disruption of the assistant’s time because she had to review the patient’s health history, perform triage, take the necessary films, and set up the room for whatever treatment she anticipated the dentist will advise. Once diagnosed, she will needed to explain any needed procedures, obtain informed consent if necessary, give post-op instructions, dismiss the patient, and quickly clean and disinfect the operatory and get set up for their next scheduled patient. There was a disruption of the financial administrator’s time to stop and give an estimate for the next visit and discuss financial arrangements.
So, yes, the entire team “did something.”
This situation could run much smoother by just changing a few things. First and foremost, there must be a clear procedure for handling emergency calls. Many times, the front office team members have little or no clinical experience, so they lack the knowledge needed to properly triage the patient when they call. Having an emergency triage sheet ready by the phone, not only prompts the front office on the questions that need to be asked, that same sheet can follow the patient to the operatory so the assistant and the dentist have a basic idea of what the problem is before the patient is seen.
Rather than tell the patient to “come on down,” the receptionist should complete the triage sheet, pull the patient’s chart to see if there is any undone treatment in the area they are complaining about. In this case, the patient was advised he needed an endo but had not returned for treatment. The patient also said this pain has been going on for quite some time (not a true emergency). The receptionist is armed with this information when she speaks to the assistant or the dentist. The dentist determines that, since the diagnosis had already been made, it would be appropriate to call in an antibiotic and pain medication to get the patient through the weekend. This would reduce the swelling and pain, and the patient can schedule for the endo.
In the event that a patient does have a true emergency that they need to be seen for, it is best to avoid using an office visit or limited exam code. Many insurance companies will consider these as a periodic exam then deny recare exams for frequency. By using D9110 Emergency Palliative code, you are providing a better benefit for your patient. The fee is usually higher to compensate for the disruption in your schedule, so the dentist benefits as well. Just be sure to document thoroughly.
Always advise the patient on the telephone that you are “working you in for an emergency visit, and your estimated portion will be $XXX when you arrive.” I suggest that you collect co-pays when the patient arrives. This plants the seed that this is a serious situation with financial obligations. Perhaps this will help the patient to value the dentist’s time and treatment recommendations in the future.
Proper team training will go a long way in avoiding unnecessary emergency visits and will make your day run smoother.
