It’s Friday afternoon. One of the chairside assistants calls in sick, 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 a crown prep is waiting to be seen in another operatory. The handpiece in the hygiene room suddenly quits working, so the hygienist has to move her patient to another operatory to finish. There are instruments piling up and lab cases still needing to be sent out. Everyone thinks, Will this day ever end?
Then, just as the assistants are starting to see light at the end of the tunnel, the receptionist comes in the lab to tell them there is an emergency patient coming in. When the assistants ask what the emergency is, she replies, “I don’t know exactly, he just said one of his back teeth was killing him.” They turn back to their pile of instruments. Their blood pressure goes sky high. Nevertheless, they take a deep breath and start to gather the necessary items to fit the emergency into the schedule.
The patient arrives and is seated as soon as an operatory becomes available. During triage, the patient states he has been in pain a couple of weeks, but swollen only for two or three days. He says that since the weekend was coming he thought he should visit us. In reviewing his treatment plan, the assistant discovers he has been noncompliant with the endo treatment that was recommended at his last recare visit. The dentist views the X-rays, prescribes an antibiotic and pain medication, and instructs the patient to schedule for the endo as soon as possible.
The assistant escorts the patient to the front and tells the receptionist he needs to schedule for the endo, and the adds, “The doctor didn’t do anything.”
The receptionist attempts to collect the patient’s co-pay for an office visit. The patient argues that he should not have to pay because, as the assistant just said, the doctor didn’t do anything. Now the front office staff is stuck dealing with a sticky situation. Sound familiar?
I cringe every time I hear a team member say, “The doctor didn’t do anything.” To begin with, this patient was an emergency call late in the day and was worked into an already busy schedule. Therefore, there was a disruption of the dentist’s time that was reserved for treating regularly scheduled patients. There was a disruption of one 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 might need. After the exam she was expected to explain the diagnosis and any needed procedures, obtain informed consent if necessary, give postop instructions, dismiss the patient, and quickly clean and disinfect the operatory and get set up for the next scheduled patient. There was also a disruption of the financial administrator’s time while she stopped to 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 changing just a few things. First and foremost, there should 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 to properly triage patients when they call. Having an emergency triage sheet by the phone not only prompts the front office to ask the proper questions, 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 a patient to “come on down,” the receptionist should complete the triage sheet, and then pull the patient’s chart to see if there is any undone treatment in the area the patient is complaining about. In this case, the patient was advised he needed an endo but had not returned for treatment. The patient also said his pain had been going on for quite some time (not a true emergency). The receptionist should be armed with this info and speak to the assistant or the dentist. The dentist can determine that since the diagnosis has already been made, it is appropriate to prescribe an antibiotic and pain medication to get the patient through the weekend. This would reduce the pain and swelling, as well as allow time for the patient to schedule the endo.
In the event that a patient does have a true emergency, it is best to avoid using an office visit or limited exam code. Many insurance companies consider these a periodic exam, and then they deny recare exams for frequency. By using the D9110 Emergency Palliative code, you are providing a better benefit for your patients. 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 and gather complete diagnostics.
Always advise patients on the phone that you are working them in for an emergency visit, and their estimated portion will cost a certain amount when they arrive. I suggest you collect copays when patients arrive. This lets them know 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 not only in avoiding unnecessary and unscheduled visits, but also in ensuring you are properly compensated for providing your patients with the care and attention they deserve in true emergencies.
Theresa K. Sheppard, RDA, is the owner of Skill Enhancement Coaching Services and Optimal Dental Insights/Career Express Dental. For more information, visit www.CareerExpressDental.com.