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Thursday Troubleshooter: This dental staff can't agree on billing for polishing

Aug. 11, 2016
This dental staff can't see eye to eye on how to bill for polishing. This is a question of interest to our Canadian readers.

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QUESTION: We recently had new employers take over the practice. Some of their changes have been for the better. But there’s one change that’s becoming a negative issue. The dentist says nothing about this problem. He leaves it to the administrator, who is his wife, and another person she has hired to manage our existing office they recently bought.

Neither one of them is a hygienist. They insist that hygiene bill a full unit of polish for every client (that is seven minutes to 15 minutes). There are no half polishes because everyone loses the half billing. The administrators insist we write it up as five-minute polish and oral hygiene instruction.

The dental hygienists in the office have said no. We have explained to them that this is not ethical and it’s fraudulent. The wife/administrator becomes angry and says we’re wrong. We’re pretty sure based on our hygiene college rules that we are right. Can you please give us an explanation we can share with her?

ANSWER FROM JO-ANNE JONES, RDH, President, RDH Connection Inc. Practicing RDHs in Canada in general practice have to adhere to the applicable provincial fee guide in terms of code utilization to reflect the services provided. For example, as a registrant in the province of Ontario, hygienists are self-regulated and governed solely by the regulatory college. We are directly accountable to our college for the way we conduct our clinical practice. Our documentation requires that we not only document fully the services we provide, but also the time for each intervention.

We’re required to document in “minutes” vs. “units” of time for each procedure code that has a time representation. For example, a recare examination is a procedural code, whereas a scaling code is based on “units of time,” with a unit being 15 minutes. We are required to document the amount of time we have scaled. Under some terms of employment, an RDH would also be required to document the codes to assist the administrative team. The RDH is accountable for the codes being billed to be in accordance with the services provided and documented.

In today’s world it would be extremely rare to have a requirement for 15 minutes of polishing outside of someone with heavy black line stain, a heavy smoker, a drug user, etc. The code representing a half unit of polishing would be the customary code to use. If the polishing goes beyond the half unit (eight minutes or more), the code for the full unit can certainly be used. If oral hygiene instructions (OHI) are being provided, the code for OHI should be used. OHI would then need to be clearly documented and in accordance with the goals set for the client.

Either way, the services provided to clients must be specific to their needs and the billing must accurately reflect both the services as well as the time spent in the dental hygiene chair. This is done to protect both the practice and the dental hygienist or clinician providing treatment. The documentation serves as a paper trail should there ever be an inquiry or investigation.

If there are any questions regarding codes, a registrant is encouraged to inquire directly with the provincial dental association for further clarification. (The above is my opinion only.)

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