Dental Information Guide 2014

Transcription

1 Dental Information Guide 2014 With guide to tooth specific information Fees effective from 1 June 2014

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3 CONTENTS Comments & Feedback To help us improve our services, we would appreciate your comments or suggestions about this publication. Please send your comments to: Customer Services Practitioner Services Dental & Ophthalmic Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB Telephone the Helpdesk on: NSS.psddental@nhs.net Code/Item guide Discretionary fee list Incomplete metal dentures Incomplete acrylic dentures Item 1 General examination time-bars Information notes relating to Item 1 Item 1 Orthodontic examination time-bars Information notes relating to Item 1 Item 10 Periodontal treatment time-bars Information notes relating to Item 10 Combination codes - General Combination codes - Orthodontic Changes to free repair and replacement Miscellaneous information 3/4 5/

4 JUNE 2014 CODE/ITEM GUIDE MAXIMUM PATIENT EXAMINATION 1A 1B 1C 1D X-RAYS - Registered/Occasional 2A[1] / 49 Small 2A[2] / 49 Medium 2A[3] / 49 Large Panoral Ceph [ORTHO] STUDY MODELS 2B Upper + Lower Duplicate set Single PHOTOGRAPHS 3 SCALING X-rays to be available for 10C 10A 10B 10B Incomplete [1st Visit] 10C 1-4 teeth 5-9 teeth teeth 17 or more teeth Additional fee for sextants FILLINGS 14A[1] Single surface 14A[2] Two surfaces 14A[3] MO or DO 14A[4] MOD 14B Tunnel Single filling Double filling 14C[1] Resin Single filling Double filling Acid etch One angle Incisal edge Two angles Cusp tip 14C[2] Glass ionomer Single filling Double filling Pin 14D SEALANT RESTORATIONS 14H Sealant only 14I Resin 14J Resin + ionomer 14G Single filling Double filling CODE / / / / MAXIMUM FILLING S Combinations of materials WITHOUT pins / acid etch / cusp tip Combinations of materials WITH pins / acid etch or cusp tip ROOT TREATMENTS X-rays to be available 15A Incisor Upper premolar Lower premolar Molar B Vital pulpotomy Remember to enter code for 1st crown [1700] or veneer [1600] Do not use occasional codes [items 47-60] for referral or partner/associates patients PATIENT APICECTOMY X-rays to be available 15C Incisor Premolar Upper molar Additional fee for retrograde VENEERS /123 Additional fee for 1st veneer INLAYS 17A[1] Single surface 2 surfaces 2 surfaces involving the incisal 3 surfaces CROWNS 17B[1] Precious metal 17B[2] NON precious metal 17C Porcelain jacket crown 17D[1] Bonded precious 17D[2] Bonded non-precious 17E Acrylic Additional fee for 1st crown or inlay POSTS 17F[2] Metal alloy post 17F[3] Prefabricated post 17F[4] Pin / screw TEMPORARY CROWN 17G WITHOUT post WITH post RE-CEMENT - Registered / Occasional 17K / 51C Inlay Crown BRIDGES X-rays and study models to be available 18A[4] Retainer Bonded precious Bonded non-precious 18C[4] Pontic Bonded precious Bonded non-precious 18D Maryland retainer Pontic TEMPORARY BRIDGE 18F[1] Lab produced 18F[2] Other RE-CEMENT BRIDGE 18G[1] Maryland 18G[2] Any other bridge EXTRACTIONS - Registered / Occasional - Updated 21[1] / 52[1] 1 tooth Permanent 2 teeth or retained 3 or 4 teeth deciduous 5-9 teeth teeth 17 or more teeth Additional fee for visits 21[2] / 52[2] 1 tooth Deciduous 2 teeth teeth 3 or 4 teeth 5-9 teeth teeth 17 or more teeth Additional fee for visits CODE / / PATIENT

5 JUNE 2014 CODE/ITEM GUIDE CODE PATIENT SURGICAL EXTRACTIONS - VISIT fee not applicable / X-rays to be available 22A Soft tissue only Bone removal on 1, 2 or 3s 4, 5, 6, 7 or 8s Impacted wisdom teeth Upper NO DIVISION 2204 Lower NO DIVISION 2206 Upper WITH DIVISION 2205 Lower WITH DIVISION 2207 POST OPERATIVE TREATMENT 23A[1] Arrest of haemorrhage A[2] Remove sutures B Septic socket 2311 GENERAL ANAESTHETIC - Deleted 01/04/2001 SEDATION 25A[1] WITH ITEM teeth 5-9 teeth teeth 17 or more teeth A[2] WITH OTHER ITEMS [adults only] < > C[2] Inhalation Fee paid for 2573 is calculated as plus The patient will only pay 80% of Inhalation 25C[2] Injection Fee paid for 2574 is calculated as plus The patient will only pay 80% of Injection ACRYLIC DENTURES 27B[1] Full Upper + Lower B[2] Full Upper Lower B[3] Partial 1-3 teeth teeth or more Note 2738 maximum denture code no longer applies: Use Upper/Lower codes. 27C[1] Full C[2] 27C[3] 27C[4] Part plate design 1-3 teeth teeth or more 2743 Single bar 1-3 teeth or more 2744 Multi bar 1-3 teeth or more 2745 REPAIRS 28A[1] A[2] A[4] Impression 2821 MAXIMUM REPAIR Upper Lower EASING 28B RELINES 28C[1] 28C[2] 28C[3] ADDITIONS CODE Upper D[1] 28D[2] 28D[3] Clasp Tooth Gum addition fee - per denture Combinations of 2 or more additions with or without repairs fee applies per denture ORTHODONTIC APPLIANCE A[1] 32A[2] 32A[3] 32A[4] 32A[5] Extra-oral traction Anchorage RETENTION 32B[1] First period Additional period 35 / 57A < 10 miles miles over 40 miles RE-OPEN SURGERY - Registered/Occasional 35 / 57B < 1 mile over 1 mile ITEM 36 - MISCELLANEOUS TREATMENTS 36A Pathological exam B Grinding D Sensitive cement PRESCRIPTION - Registered/Occasional - cannot claim with treatment items 36E / 48 ACUTE INFECTION - Registered/Occasional 37 / 56 DRESSINGS - Occasional - Updated 3641 / / A[1] Permanent 1 tooth or retained deciduous 2 teeth Each additional 50A[2] Deciduous 1 tooth 2 teeth Each additional CODE Lower / / / / / PATIENT RETENTION APPLIANCES 32B[2] REPAIRS - Updated Removable Fixed Pressure C[1] C[2] One repair Each additional C[3] (upper + lower) IMPRESSION REPLACEMENT APPLIANCES - REG 9 charge is decided by the Health Board 32E[1] Space maintainer E[2] Removable E[3] Simple fixed E[4] Multiband E[5] Functional DOMICILIARY VISITS - Registered/Occasional - supporting observations should be given JU

6 JUNE 2014 DISCRETIONARY LIST These are the more commonly used discretionary fee items. Some items are often claimed in a course of treatment with discretionary items, and also shown here. The code + fee should be entered onto the GP17. All other discretionary fees must be obtained by contacting Practitioner Services on Enter on the GP17 as previously described. ANAESTHETICS - For treatment other than item 21 use codes as detailed below CODE NO GENERAL ANAESTHETIC Deleted from the statement of dental remuneration 24A3 [CHILD] 24A2 [ADULT] SEDATION TREATMENT VALUE UP TO OVER A3 [CHILD] A2 [ADULT] [non-discretionary] PATIENT [ADULT only] TREATMENT DESCRIPTION CODE NO PATIENT RE-CEMENT VENEER SCALING - Incomplete 10B [1st Visit only] OPERCULECTOMY This group has both discretionary and non-discretionary elements RE-CEMENTING A CROWN + PROVIDING A NEW POST 1. Cast metal alloy core + post [F2] Radix Anchor or Kurer Crown Saver Prefabricated post [F3] Pinned core [F4] Removal of Crown prior to repair Removal of Post prior to repair [this item is non-discretionary] REPAIR OF A PORCELAIN USING A SPECIAL PORCELAIN REPAIR KIT 1 unit units units RE-CEMENTING A BRIDGE + PROVIDING A NEW POST 1. Cast precious metal core + post [B1] Cast non-precious metal alloy core + post [B2] Radix Anchor or Kurer Crown Saver Prefabricated post [B3] Pinned core [B4] RE-CEMENTING A BRIDGE + PROVIDING 2 NEW POSTS 1. Cast precious metal core + post [B1] Cast non-precious metal alloy core + post [B2] Radix Anchor or Kurer Crown Saver Prefabricated post [B3] Pinned core [B4]

7 JUNE 2014 DISCRETIONARY LIST DESCRIPTION REPAIR TO PORCELAIN BY RE-BONDING PORCELAIN IN A LAB CODE NO PATIENT 1 unit units units REPAIR TO PORCELAIN USING A SPECIAL PORCELAIN REPAIR KIT 1 unit units units Sectioning / Removal of Bridge Repair of Bridge using a Porcelain Veneer REPAIRS INVOLVING METALWORK [SOLDERING/WELDING] Repair fee [Fracture/Re-fix tooth] [this item is non-discretionary] Impression fee [this item is non-discretionary] Metalwork fee Total Repair fee [Clasp] Impression fee [this item is non-discretionary] [this item is non-discretionary] Metalwork fee Total This group has both discretionary and non-discretionary elements ADDITIONS INVOLVING METALWORK [SOLDERING/WELDING] Addition [Tooth] [this item is non-discretionary] Metalwork fee Total Addition [Clasp] [this item is non-discretionary] Metalwork fee Total Note - Do not claim an impression fee as this is already included in the Addition fee Stripping Fee Reconstruction of a metal denture [this item is non-discretionary] Upper 1-3 teeth teeth teeth Note When reconstructing a metal denture involving stripping, claim the stripping fee and add the fee for the denture corresponding to the number of teeth involved. [this item is non-discretionary] Lower 1-3 teeth 4-8 teeth 9+ teeth Example To reconstruct a partial upper denture involving 5 teeth: Add to : =

8 JUNE 2014 INCOMPLETE METAL DENTURES CODES AND S 62E - 25% 62F - 50% F / F F / F F / F / P / P / P / P / or more P / or more P / / F / F / P / P / P / P or more - / P or more - / P G - 70% 62H - 85% 62i - 95% Horseshoe / Plate Horseshoe / Plate Horseshoe / Plate F / F / F / P / P / P / P / P / P / or more P / or more P / or more P / / F / F /F / P / P /P / P / P /P or more - / P or more - / P or more - /P Skeleton - Single Connecting Bars Skeleton - Single Connecting Bars Skeleton - Single Connecting Bars P / P / P / or more P / or more P / or more P / / P / P / P or more - / P or more - / P or more - / P Skeleton - Multiple Connecting Bars Skeleton - Multiple Connecting Bars Skeleton - Multiple Connecting Bars P / P / P / or more P / or more P / or more P / / P / P /P or more - / P or more - / P or more - / P

9 JUNE 2014 INCOMPLETE ACRYLIC DENTURES CODES AND S 62A - 25% 62B - 50% F / F F / F F / F / P / P / P / P / or more P / or more P / / F / F / P / P / P / P or more - / P or more - / P C / 3 % 62D - 95% F / F F / F F / F / P / P / P / P / or more P / or more P / / F / F / P / P / P / P or more - / P or more - / P Please note: From 01/12/98 the maximum denture code/fee no longer applies - use upper and lower codes. When a patient returns to have a denture fitted, submit a GP17 to us requesting a balance fee to be paid. Do not enter item 27 codes when claiming incomplete dentures. You must observe the requirements of narratives and provisos in the statement of dental remuneration for each item. 8

10 ITEM 1 - GENERAL EXAMINATION TIME-BARS USING THE TABLE Identify the exam being claimed in left-hand side of the table and cross-reference along the table to ensure a previously claimed exam has not been paid within the stated time period. EXAMPLE If you wish to claim an item 1(a) exam, and you previously claimed an item 1(c) you would need to wait 5 complete. You cannot claim an If you have Item 1a Item 1b Item 1c Item 1a Trauma carried out an Item 1a Item 1b Item 1c INFORMATION NOTES HISTORICAL CLAIM AND TIME-BAR PERIOD In the last 5 complete In the last 23 complete In the last 5 complete In the last 23 complete In the last 5 complete In the last 23 complete In the last 23 complete (see note 8) 1 Time-bar checks are carried out against a history for the same dentist. 2 The same den iginal dentist, a partner/principal/associate, or another dentist with whom the original den rangement. 3 The examination time-bar is calculated based on the acceptance date of the claims. 4 The time-bars do not apply if the examination is a result of trauma. The trauma box must be ticked and observations given. 5 To calculate complete, for example 5, add 6 months, the time bar will expir y of the sixth month. For example: Claim on 18/03/2002, the next claim is possible on or after 01/09/ If a patient returns after their registration has lapsed, the 23 month time-bar for Item 1(b) or 1(c) examinations still applies. 7 The Item 1(c) time-bar does not apply when the total fee for treatment claimed exceeds Item 1(a) is most likely to be claimed for a regular patient, when the dentist is familiar with the patient s oral health. 9 Item 1(b) is most likely to be claimed for a patient who is new to the practice. Charting of the patient s periodontal status must be reported in the patient record. 10 Item 1(c) may be claimed in connection with Item 10(c); Item 18; when treatment is of special complexity involving Items 16, 17; in dentate cases involving Item 27(b) and 27(c), and when the total fee for treatment claimed exceeds One additional Item 1(a) may be claimed for patients who are pregnant or who have borne children in the past 12 complete. 9

11 ITEM 1 - ORTHODONTIC EXAMINATION TIME-BARS USING THE TABLE Identify the exam being claimed in the left-hand side of the table and cross-reference along the table to ensure a previously claimed exam has not been paid within the stated time period. EXAMPLE If you wish to claim an item 1(b) Orthodontic exam, and you previously claimed an item 1(c) you would need to wait 23 complete. You cannot claim an If you have Item 1a Item 1b Item 1c carried out an Orthodontic Orthodontic Orthodontic In the last 5 complete In the last 5 complete Item 1a Orthodontic In the last 23 complete In the last 23 complete Item 1b Orthodontic Item 1c Orthodontic HISTORICAL CLAIM AND TIME-BAR PERIOD In the last 5 complete In the last 5 complete In the last 5 complete In the last 23 complete In the last 23 complete INFORMATION NOTES 1 Orthodontic examination fees can only be paid for a patient who has an established or developing malocclusion. 2 An Item 1(c) examination is only payable when study casts and radiographs (if appropriate) are available, and are recorded as available on the claim; the referring dentist or hospital may provide models or radiographs for the orthodontist. 3 An item 1(a) and an item 1(c) are not payable where there are no permanent teeth present. 4 An Item 1(c) claim on a GP17(0) does not bar simultaneous claims for Items 1(a) or 1(b) on GP17 forms when the dentist is also responsible for the patient s general care. 5 Orthodontic examinations must be made using GP17(0) forms, with the appropriate information detailed. 10

12 ITEM 10 - PERIODONTAL TREATMENT TIME-BARS USING THE TABLE Identify the exam being claimed in left-hand side of the table and cross-reference along the table to ensure a previously claimed exam has not been paid within the stated time period. EXAMPLE If you wish to claim an item 10(b), and you previously claimed an item 10(c) you would have to wait 9 complete. If you have You cannot claim an carried out an Item 10a Item 10b Item 10c Item 10a Item 10b Item 10c HISTORICAL CLAIM AND TIME-BAR PERIOD (normally 2 complete ) 9 complete 9 complete 9 complete 9 complete INFORMATION NOTES 1 Time-bar checks are carried out against a history for the same dentist. 2 3 The time-bars for item 10 are calculated based on the acceptance date of the historical claim to the completion date of the current claim. 4 Only one item 10 is payable per course of treatment. 5 Treatment under item 10 is inclusive of oral hygiene instruction, therefore a fee under item 6 cannot be claimed at the same time. 6 Item 10(a) is only payable in conjunction with an item 1(a), (b) or c) exam or where an exam was claimed within the previous 11 complete. 7 Item 10(b) is only payable in conjunction with an item 1(a), (b) or (c) exam or where an exam was claimed within the previous 11 complete. 8 Item 10(c) is only payable in conjunction with an item 1(c) exam or where an item 1 (c) exam was claimed within the previous 23 complete. 9 Item 10(c) - radiographs must be available and recorded as available on the claim. 11

13 JUNE 2014 COMBINATION CODES - GENERAL* DESCRIPTION COMBINATION OF REPAIRS REGISTERED OCCASIONAL UPPER Re-fixing a clasp + 1 fracture Re-fixing a clasp + 2 fractures Re-fixing a clasp + 3 or more fractures LOWER Re-fixing a clasp + 1 fracture Re-fixing a clasp + 2 fractures Re-fixing a clasp + 3 or more fractures MAXIMUM REPAIR PER DENTURE U / - - / L COMBINATIONS OF ADDITIONS + REPAIRS 1 addition [clasp] with 1 repair [fracture] [balance fee**] addition [tooth] with 1 repair [fracture] addition [gum] with 1 repair [fracture] addition [clasp] with 2 or more repairs [balance fee**] addition [tooth] with 2 or more repairs [balance fee**] addition [gum] with 2 or more repairs [balance fee**] addition [clasp] with re-fix clasp [balance fee**] addition [tooth] with re-fix clasp [balance fee**] addition [gum] with re-fix clasp [balance fee**] Any 2 additions with or without repairs - Fee * Found in proviso for item 28/55 ** fee payable under item 28 and 55 is Please note - no fee for impression can be paid with addition 12

14 DESCRIPTION JUNE 2014 COMBINATION CODES - ORTHODONTIC COMBINATION OF REPAIRS REGISTERED UPPER 32[C][2] + 1 repair under 32[C][1] [C][2] + 2 or more repairs under 32[C][1] [C][2] + 3 or more repairs under 32[C][1] LOWER 32[C][2] + 1 repair under 32[C][1] [C][2] + 2 or more repairs under 32[C][1] [C][2] + 3 or more repairs under 32[C][1] Please note - for item 32, the dentist must have fitted an appliance before any fee is payable. UPPER OCCASIONAL 55[E][2] + 1 repair under 55[E][1] [E][2] + 2 or more repairs under 55[E][1] [E][2] + 3 or more repairs under 55[E][1] LOWER 55[E][2] + 1 repair under 55[E][1] [E][2] + 2 or more repairs under 55[E][1] [E][2] + 3 or more repairs under 55[E][1] MAXIMUM REPAIR PER APPLIANCE U / / L

15 CHANGES TO FREE REPAIR AND REPLACEMENT From 1 December 2012, a dentist cannot claim for repairing or replacing the following treatments when this happens within 11 complete of the original restoration by that dentist or another dentist acting on the dentist s behalf: Permanent fillings: Conservative treatment items 14 (a) - ( d ) and (f) - (j) Conservative treatment, special to minors, items 44 (a), (b) and (e) Occasional treatment items 58 (b) - (f) Occasional treatment, special to minors, item 60 (a) Root fillings: Items 15 (a) and (d) Inlays and Crowns: Items 17 (a) - (k) Bridges: Items 18 (a) - (h) Occasional treatment items 51 (d) and (e) A dentist could still claim however where the repair or replacement is as a result of trauma external to the mouth, as defined in Section I of the Statement of Dental Remuneration, and observations are clearly given in the claim. No patient charge applies if: It is within 12 months of the original treatment, and is like-for-like, and is subject to the following exclusions: - If private treatment has been applied; - Is intended to be temporary; - Is at the insistence of the patient, but against the advice of the dentist; - Another dentist has carried out occasional (other than temporary) treatment within 12 months, and it doesn t fall under the same dentist rule. - The dentist thinks restoring the tooth by repairing or replacing would not work, and that different treatment is needed; - It is due to trauma. Other conditions may apply, and we recommend you familiarise yourself with: NHS (General Dental Services)(Scotland) Regulations 2010 at : MISCELLANEOUS INFORMATION patient charge Prior approval limit Payments will arrive in your bank account on the twentieth of each month (or the Friday before, if the twentieth falls on a weekend). GP17 paper claims Closing date for each schedule month (Example below is for June) Electronic Data Interchange (EDI) Last working day of schedule (30 June in this example) Seventh day of the following month (7 July in this example)* *Subject to change. Please check your broadcast messages. 14

16 Helpdesk Tel Mon-Thurs 8.45am pm & Fri 8.45am pm or nss.psddental@nhs.net When contacting Practitioner Services please quote your List Number. For Electronic Data Interchange (EDI) dentists, please quote your Location Number/Code.