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What happens if I back date a clinical note?

Your clinical note is part of your legal documentation for your patient’s chart. When I say, “legal documentation,” to me, this means that it cannot be deleted or altered without some kind of security feature in place. There are only a few places in Dentrix that I consider “part of the legal documentation” and the clinical note is one of those places. So what exactly happens to make it a secure place to make clinical notes and what happens if you need to edit a note or back date a note?

First, it is important to know that the clinical note will be locked into history if you sign the note or you run the month end process. If you need to alter the clinical note after it has been secured, the only way to do this is with an Addendum. The Addendum will attach itself directly to the original note with today’s date. After you have saved this Addendum, it is also locked up into history and cannot be altered or deleted. If you ever need to print out your patient’s clinical notes, you will see the date of entry and the date of the Addendum.

Now, there may be times when you will need to back date a note. For example, if the doctor comes in the office on the weekend to see a patient and he does not write up the clinical note on that day, he will need to back date the note. Another example might be if you forgot to write up your clinical note for a patient visit (we are all human) and you need to back date it. If you are back dating a clinical note into a month that has already been closed out, your note will automatically be secured into history. Also, if you back date a note, it will show the date it was created and the date it was backdated to. See image below.


Knowing how your clinical note documentation will present when printed is important to know if and when you need to show your clinical documentation. The Dentrix software does a great job to show the dates and times so you can feel confident in the integrity of your clinical documentation.


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Every patient has unique situations so let's chart them correctly

Every patient is unique and making sure his or her tooth chart accurately represents his or her uniqueness is important when you are transitioning from that paper document to the digital document. Patients have diastemas, missing teeth, unerupted teeth, retained primary teeth and lots of other situations that you want to document on the tooth chart. How do you keep it all straight and chart it as accurately and quickly as possible?

Using the Dentrix conditions is a way that you can chart all those unique features that you find and want to make note of. You can customize the conditions with different paint types, edit the description and add them to your quick buttons for faster charting. In this article, I am going to go through a few of the common conditions and show you some screen shots of what it might look like on the tooth chart.

  • Diastema – The default condition in Dentrix for Diastema is Open Contact. So if you look in your list of Conditions and find open contact, that is the best one to use. If you want to edit the description, you can go to the Office Manager > Maintenance > Practice Setup > Procedure Code Setup > select the Conditions category, select the Open Contact and click on Edit. Then you can edit the description to say Diastema if you want.
  • Missing tooth, closed space – If you have a patient who had a four-bi extraction as a kid and the orthodontist closed the space, you can use the Drifting Mesial condition to show that the space has been closed. This could also be used if a patient lost a tooth and the teeth have moved into the open spot.
  • Unerupted tooth – If your patient has a 3rdmolar or another tooth that has not fully erupted yet, you can use the condition Unerupted tooth. I have seen offices either use the U on the tooth to mark it or circle the tooth. You can choose what works best for you. If you want to change how it paints on the tooth chart, go to the Office Manager > Maintenance > Practice Setup > Procedure Code Setup > select the Conditions category, select the Unerupted and click on Edit. Then there is a drop-down menu for Paint Type.


If you have a patient with a retained primary tooth, then you would highlight the tooth and click on the Primary/Permanent icon on the tool bar and click on Change Selected to just change that one tooth. Other options here would be changing all the teeth to primary or all to permanent.


I think having an accurate picture of your patient’s dentition helps with the visual aspect and makes the perio chart more accurate. Now that many offices are using the digital record instead of paper, it is important that you treat the digital chart with as much detail as the paper chart.

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Are you that doctor?

Are you the doctor who wants to give the patient a treatment plan estimate with a total case fee instead of a line item estimate? I have worked with many of you and I get it. You want to offer your patient a total case fee that includes everything for the end result.

I was working with a prosthodontist a few years back and he was one of those doctors who wanted a total case fee not a line item treatment plan. So we worked together and got creative with the software. This question came up again this week while I was talking with one of my colleagues so I thought I would share some ideas with you.

Here is what you can do. Create your custom procedure codes in the Office Manager. Go to the Office Manager > Maintenance > Practice Setup > Procedure Code Setup and add your new in-office custom codes. Here are some examples . . .
  • Implant Option – Crown & Bridge
  •  Implant Option – Fixed Hybrid
  • Full upper rehabilitation
  • Full lower rehabilitation
  • Four on the floor (I don’t know what this is but I have heard it)

Make sure when you are creating these custom in-office procedure codes that you mark them to not bill to insurance because you will have to bill things out by line item in order for your chart to look accurate, but this is a way you can provide a total fee estimate that the patient will understand.


Now when you treatment plan one of these codes, you can note everything that is included in the note field (see the screen shot here). Then, when you print out the estimate for the patient, it will only show a full fee and then what is included in that fee. Let me know what you think. I would love to hear some feedback.


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How to generate an Unscheduled Treatment Report for patients who have already said "Yes" to treatment.

Back in February, I wrote an article on using visual tools to help communicate the status of the treatment plan with your entire team. If you want to re-read it, CLICK HERE. If you have implemented some of these visual aids, did you know that you can filter one of the Treatment Plan reports to give you a narrower search?

Open the Treatment Planner or the Treatment Plan Panel in the chart and click on Print. For most of you, this is how you would print a treatment plan estimate for the patient … but have you ever printed the Practice Treatment Case Report? Even though I am all about going paperless, this report gives you some great search tools to find patients who have unscheduled treatment and have been marked with a particular status.

Going back to my February article, if you have marked the case with a particular status, then you can search for it. For example, let’s say you have marked a case as Accepted or High Priority, then it is now searchable. Click on the Print > Practice Case Status Report and select your filters. See the image below to follow along.
  • Fig 1 shows how you can choose a Case Status. You can select all the cases you have marked as accepted and get a call list from this selection. If you have been reading my blog for a while, you know how much I love the Treatment Manager. However, it does not have this filter (which I think is a great tool).
  • Fig 2 shows how you can select a Case Severity. If you are marking your cases as Immediate, Eventual or Optional, then you can filter your report by one of these choices.



Using these visual tools can help you and your team communicate better and give your admin team the options necessary to generate a really good call list when they are following up with patients and trying to fill openings in the schedule.

These are just a couple of examples of how you can use the status and severity tools. You can discuss with your team how they would best serve your practice.

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Hygienists . . . you are one of the primary educators in the practice

We all know that research shows the systemic links between oral health and the rest of the body, especially the relationship between periodontal disease, cardiovascular disease, diabetes and respiratory disease. As oral health providers, it is our responsibility to educate our patients about the significance of periodontal disease and how it will affect the rest of their body.

One of the tools you have as a hygienist is the Dentrix perio chart module, but do you know everything that it will do to help you with visual aids for educating your patients? Let me show you a few of my favorite things you can do with your perio chart.

  1. Use the Graphic Chart to show your patient what a 9mm pocket looks like or where there is a lot of bleeding. You can enlarge a specific quadrant or arch to show specific areas in more detail by clicking on the + in the corners and center of the graphic chart. You can also click on the Show Options button to include the data measurements.
  2. If you want to show your patient any changes in their perio chart, you can compare up to four exams at a time. I would recommend only comparing two exams at a time because then it will show you a colored arrow if the pocket depth got better or worse (a green arrow means it got better and a red arrow means it got worse).
  3. You can print both of these two visual aids for your patient to take home.



As the hygienist, you are one of the primary educators in the practice. Use the tools you have in your software to enhance the case acceptance for perio therapy and help your patients work toward a healthy lifestyle. These diagnostic techniques are extremely important to getting your claims paid, but far more important is educating your patients about the link between other oral health and systemic diseases.

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Create an environment for efficiency and accuracy with customizing your toolbars

What do I love about Dentrix? I love the fact that you can customize almost anything. I realize that some people think that too many choices leads to confusion and lack of efficiency, but I think the exact opposite. If you can narrow down the choices to exactly what you want in your practice on your monitor, on your reports, on your toolbar, etc., I feel it makes things more precise and streamlined.

I have written a lot of articles on building customized templates, clinical charting button sets, and creating consistent views for the treatment rooms. This systematic type of setup creates an environment where team members thrive on routine and it also creates fewer mistakes. I often hear during training sessions, “What do all these icons do?” or “Do I really need all these icons on my toolbar?” Well . . . the answer is not usually.

In the treatment room workstations, just like you create custom button sets and appointment book views, I would recommend removing several of the icons from the toolbar that your clinical team will never use in the operatory. By cleaning up the toolbars, the eyes have less to scan through which helps make you more efficient. There are two different ways to clean up your toolbars . . .  

The toolbars on the Patient Chart have a drop down menu where you can add and remove items by checking and unchecking. I would recommend setting all the toolbars exactly the same in every treatment room because when the doctor, assistant, or hygienist has to go work in a different room, you want it to look the same. Here are a few icons you could remove (not should, but could) from the toolbars on the Patient Chart. If you decide to remove more than what I have listed, be my guest.

  •  DxWeb – In my last blog, you learned that this runs on only one computer (usually a front office computer) so there is no need for it in the back.
  • DentriXlink – Unless you are bridging a piece of technology (imaging, CT scan, etc) with Dentrix, you will not use this icon in the back.
  • QuickLetters – Most clinical room computers are not equipped with Microsoft Word so this will not work without Word.
  • Send Message – Most clinical room computers are not equipped with Microsoft Outlook so this will not work without using Outlook. Also, you would want to send out any protected patient information using a secure email server.
  • Treatment Manager – This icon will pull up a report on unscheduled treatment. Since this is a managerial report and will require a phone to be handy so you can call the patient, this icon will typically not be used in the clinical room.
  • Marketplace – Even though the Marketplace has some awesome tools that work with your Dentrix software, I hope that the clinical team members are not shopping while they are seeing patients. This can be removed from the clinical room computers.
On all the other modules (Appointment Book, Family File, Ledger, Office Manager), you will need to right click on the empty space on the toolbar to add, remove, and move around the icons. Here are a few recommendations for which workstations should have what on their toolbar.

  • If you are using Perfect Day Scheduling in your practice, then I would make sure that it is turned on the clinical room computers so you can see all the blocks but then remove this icon off the appointment book. I have seen Perfect Day Scheduling get accidentally turned off and then all the blocks disappear off the schedule.
  • The DxWeb icon can be removed from the computers where it does not run every day.
  • The DentriXlink can be removed from the administrative modules if you want.


Keeping your toolbars consistent and clean will create an environment of efficiency and accuracy. Like I said before, “I love how much I can customize Dentrix. It is a wonderful thing!”

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Using visual tools to communicate the status of the treatment plan


How do you communicate the status of the treatment plan with your team? Does your team know if the patient has accepted treatment? Is the patient okay to do all the treatment this year or is he or she breaking it up into two benefit years?

What I see with most dental teams is that the clinical discussion happens in the consult room or the treatment room with the doctor or hygienist … and then the patient is brought up front to talk with the financial coordinator where the financial discussion can change everything. If the doctor looks at the treatment plan later in the day, will he or she be able to clearly see what the patient accepted? When the patient is scheduled for the first visit, will the clinical team be able to clearly see the path for completing treatment?

There are some tools you can use on the treatment plan that can greatly improve your communication with your team. These non-verbal tools can help your clinical team clearly understand the patient’s wishes when he or she is sitting in your operatory. Here are three key features that are easy to use and visually obvious for the back and front.
  • The Stop Light – aka: Case Severity.  If a patient has lots of stuff on his or her treatment plan and you want to separate the treatment by priority, the colored stop light is an easy way to show this. Here are some examples that I use in my practices.
    • Red – Stop! The patients says no at this time. Maybe this is esthetics or that nightguard they don’t want to do right now.
    • Yellow – Maybe! The patient wants you to wait for next benefit year or until he or she comes up with the money.
    • Green – Go! The patient is ready to schedule and wants to get all this treatment completed in this benefit year or as soon as possible. This can help if the patient is in the chair and the doctor has extra time to add more treatment today.
  • Rename the Case – I used this a lot in my practice because it was a way I could clearly define what the case is. You could rename it “Priorities” or “2016 Benefit Year” or “Upper arch rehab.” Whatever you want to rename it, this really helps your team understand what the case is.
  • Claim Status History - You can add a follow-up note on any of the treatment plan cases and these notes will show up on the Case Status History tab. This can help your team know if the case has been reprinted, proposed, followed up on, or accepted.

Non-verbal communication is so important for the back and the front teams so they can be in the know about patient care. I hope these visual tools help you relay that important information.

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Are you an organizational freak?


I am an organization freak. If you walk into my closet, you will find my clothes arranged not only by style but also by color. Everything has a place. The same thing applies for organizing your patient’s chart. I go into offices that use color-coded forms in their paper chart or stickers to designate certain things.

When you are organizing your patient chart in Dentrix, you can organize certain things to make it work better for you and more efficient for your team. If you are using the clinical note templates, you will notice that there are about 17 categories listed. What I find in every office I work with is that they probably use about six of those categories. For example, a general dentist might have templates in Hygiene, Restorative, Fixed Prosthetics, Periodontics, and Endodontics, where as a pediatric dentist might only use Hygiene, Exams, and Restorative.

My point is that when you have 17 categories listed and you are only using four to six of them get rid of the ones you are not using. You have the flexibility here to combine, eliminate, and add your own categories. Make the list work for you.

First, go in and delete any clinical note templates you will never use then delete the category. For example, if you are a periodontist then delete the endo templates and the endo category. Next, rearrange the categories so that the most frequently used categories are on the top. Finally, create categories that are not listed but you would use in your office. I have worked with some offices where we have created categories for Products, TMJ, Sleep Apnea, etc. If your practice has multiple doctors, you can create categories specific for their templates. For example, Dr. John’s templates, Dr. Joe’s templates, Susie’s templates, etc.

Keeping things organized helps your team become more efficient and productive. Take advantage of all the customization that your Dentrix software has to offer and you will become a super-user.

Check out other blog posts on the topic of customization and efficiency in your patient chart:

Become Super Efficient with your Templates
Stop all that Clicking

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Expand your Medical Alert Notes with G6 and Questionnaries


When I first saw all the new and exciting features with Dentrix G6, I was eager to learn how to apply them into my everyday workflow. There is a new feature that enhances something I have been teaching for a long time and that is the health history update. If you have been reading my blog for a while, you know that I love using the Questionnaire Module for updating the health history update because it is a secure location, keeps a chronological history, and is super easy to use.

Watch my video to learn about this cool new feature.

 
 


If you are new to Questionnaires, please read these articles to learn more.

Creating a form - CLICK HERE
New Patient Forms - CLICK HERE
Documentation - CLICK HERE
 

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Oops! What to do when the wrong tooth was posted


Have you had a patient in your chair for his or her 6-month checkup and, while you are perio charting, you notice that the wrong tooth is missing. After further investigation, you realize that the patient was in for an extraction three months ago, but the wrong tooth was set complete. You don’t know what to do, but the tooth chart needs to be fixed.

This happens more than you think. Sometimes the mistake is caught before month end is run and the procedures are locked up in history so it can be fixed with just a change of the tooth number. But what do you do when the procedure has been posted, sent to the insurance company, paid, and put in history? Do you leave it? No, that is not the right answer. You must correct it and, if the patient has insurance, you should correct it with the insurance carrier as well.

The correct way to fix this situation after the procedure is to invalidate the procedure in history, post the correct procedure and tooth number, and then adjust the ledger as necessary. There are two steps here . . . invalidate and the adjustment. When you invalidate a procedure, it only takes the procedure off the tooth chart. It does not change the ledger. You can invalidate the procedure from the patient chart or the ledger. From the ledger, double click on the procedure and click on the Invalidate Procedure in the upper left corner of the edit procedure window. From the patient chart, you can highlight the procedure, right click and select invalidate, or highlight the procedure and click on the invalidate icon on the toolbar.

After you have invalidated the procedure, then you can repost it on the ledger and make an adjustment to correct the patient balance. You will also need to fix the history with the patient’s insurance company … but this can be challenging. More than likely, you will need to send in clinical notes to prove the mistake and even send in X-rays.

In the end, having an accurate clinical record for your patient is the recommended option. Your patients’ clinical histories will follow them when they move or change insurance companies so it is best to keep their records as accurate as possible.

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