APPENDIX B Organization of HealthCare Example
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1 10-1. emergency visits appropriate triage, treatment and follow-up Emergency Pt.: a. Triaged by Dr. with differential Diagnosis b. Radiograph taken by assistant c. Dr. confirms Diagnosis & does Treatment d. Appropriate FU scheduled if needed or pt scheduled for an initial visit.(appt. in 10 days and recall if missed) Quantitative (April and Oct) Comprehensive Examination as scheduled appointment a. Full mouth x-ray (FMX) bite wings or panograph is taken by assistant. FMX consists of periapical x-rays including bite wings. representati ve representati ve b. Prophylaxis or polishing of teeth & 80 Search Criteria: Emergency visit code: Search Criteria: Emergency visit April review (Sept 1, 2007 to Feb 28, 2008) Oct. review (March 1- Aug 31, 2008) code: D0140 & or D9110, 10 charts per dentist 10 charts per dentist Peer review 80 Code # D0150 and D1110 (new code combination for 2007) Comprehensive Exam and cleaning in last year
2 supra-gingival scaling is preformed by hygienist. c. Initial exam is preformed by doctor Quantitative (June) Initial exam requirements 1-5 Document #10-2 attached. Peer Review 10 charts per provider Initial Periodontal Therapy Initial Periodontal Therapy is scheduled with the hygienist and consist of: a. periodontal charting b. periodontal scaling / root planning c. re-evaluation d. follow-up based on severity of periodontal issues e. Appropriate referral if no resolution of pocket depth Quantitative (August) Initial Periodontal Therapy protocol attached (#10-3) expanded information for a-e Rep. 80 Peer Review 10 charts per hygienist code: D4342 & D charts per hygienist
3 10-6. Initial and Emergency visits chart reviews Qualitative (September) Protocol of exam attached (#10-6) Rep. 80 Peer review 10 charts per provider (Charts to encompass charts with dental codes D0120, or D0140, or D0150 ) Competence and evaluations are done yearly for dental staff members. Results are reported to HJA Board of Directors in May of each year. (7-9 HR) (May) Rep & HR Manager Report number completed 10- TX Completed within 1 year of Comprehensive visit. Oral Health Performance Measure: Percentage of dental patients seen for a comprehensive visit who completed their treatment plan within one year of the 70 charts randomly selected per calendar year reviewed. Universe: Pt with code D0150 Exclusions: pt. who transferred from CHC during the yr. after their comprehensive visit.
4 comprehensive visit Appropriate follow-up for selected high risk procedures such as: Extractions_-July Quantitative. Extraction (refer to Pt. National Safety Goals-(wrong site) ADA, recommendation ) Time Out Taken (T.O.T.) documented in medical record for all dental surgical procedures to insure the removal of the correct tooth/teeth. Extraction: 1. Consent obtained (Including risks, benefits, & alternatives.) 2. Results of procedure 3. Follow-up if indicated with pt. 4. Complications noted and appropriate follow- Dir. 100% TOT Peer review of all dentists
5 (July) up as needed. 5. Evidence of having marked x- ray or dental chart as to tooth to be extracted. 5. Time out documented
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