Dr. Leonard Gordon is a clinician at the Gordon Center for General and Advanced Dentistry in Maryland. In addition, he is the dentist on staff and Clinical Treatment Advisor for Van Hook Dental Studio in Tempe, Arizona. Having more than 25 years in implant single, multiple, and full arch restorations,
Dr. Gordon brings a unique ‘time tested’ approach to his restoration design and prosthetic implementation. He developed the GORDON PROTOCOLTM to aid practitioners in implant arch prosthetic finalization. He lectures extensively on the Application of the Immediate Load Full Arch Implant Procedure for the General Practitioner.
Dr. Gordon uses his many years of general practice to help facilitate treatment and communication between Van Hook Dental Studio and the many dentists who use their services. He graduated from the University of Maryland School Of Dentistry and previously taught Restorative Dentistry at that Institution.
Update to Medical Device Excise Tax:
The CDT dental procedure code for billable procedures is D9985.×
Medical Device Excise Tax
Many Dentists have called us asking what is the Medical Device Excise Tax. How does it affect the dental practice overhead? And is there anything an insurance-based practice can do to lessen the impact of this new expenditure on the bottom line?
What is the MDET?
The MDET is a surcharge tax that was put into effect with the passage of the Patient Protection and Affordable Care Act of 2012. This was designed as a measure to partially fund the universal health care. It is a tax on more than 180,000 medical and dental devices. Consequently, dental manufacturers have raised their prices (more than just the 2.3%) with the knowledge that some of the increase in fees will be paid to the federal government. So, the cost of your dental supplies has been increased. Also, there has been an increase in the cost of necessities to all dental laboratories. Dental laboratories have passed these costs on to the dentist by either raising fees (and not mentioning the reason), or charging only a pass thru surcharge, or using a combination of raising fees and pass thru surcharge.
How does it affect your dental practice overhead?
Expenditures to the lab will increase. Dental supplies cost more. Dental instruments cost more. Thus, less net income = less take home money!
Is there anything an insurance-based practice can do to lessen the impact of this new expenditure?
YES!!! First, Your ADA is aware of the squeeze on the dentist. On February 28 and March 1 and 2, the ADA Council of Dental Benefits will be meeting in Chicago. One of their chief duties is dental code maintenance. They specifically have an agenda item to deal with this new overhead increase to dentists. If enacted, there will be a new code that dentists can submit to insurance companies for reimbursement. If the request is accepted, it would be effective January 2014. However, this does not address the problem for the next 10 months!
As clinical advisor at Van Hook Dental Studio, my advice is as follows:
For each patient with a billable procedure, submit D9999–unspecified adjunctive procedure, by report. The report can use the simple phrase as “Necessary increased expenditures for procedures as mandated by the MDET”. My guideline recommendation would be from 2 or 3 dollars per patient. If your practice had 20 or 30 billable patients per day this would generate between 40 and 90 dollars per day. Insurance companies probably won’t cover this expense, but it should be an allowable charge for the patient to pay to you. When a code becomes effective, the insurance companies will probably begin to cover this charge until they do an overall fee assessment and incorporate this increased reimbursement. (This has a precedent. In the late 1980’s/early 1990’s, there was an infectious disease code that dentists could submit for reimbursement. This revision was deleted years later as insurance companies bundled their reimbursements.)
Always remember: It’s not how much you produce, it’s how much you take home.
Q: For an anterior implant, when should I use a screw-retained crown and when should I use a CAD/CAM abutment and cemented crown?
A: A screw-retained crown should only be used if the implant placement is slightly lingual so the screw access hole comes out through the lingual aspect of the Crown. Because of the normal anatomy of the maxilla, most implants are placed exiting the middle of the socket area and may have a slight labial inclination. With this type of placement the screw access hole would come out through the facial of the crown. A properly designed Zirconia CAD/CAM abutment and e.max all ceramic cemented crown will provide excellent aesthetics. Because of recent articles about cement entrapment issues with cement-retained crowns, more surgical specialists are placing their implants more palatal to give options for both screw or cement retained crowns in the anterior regeons.
Note: The access hole can have an effect on the overall shade and color match of the crown. After the screw is blocked out, the remainder of the access hole should be blocked out with a composite that closely matches the shade of the zirconia abutment used. This will ensure that the underlying color is even and won’t effect the shade of the e.max crown.
Q: I had a wax try-in with teeth for a complete denture. The occlusion seems proper and the anterior set up is aesthetically pleasing. But now when the patient smiles, she complained she has a “gummy smile.” How do I tell the lab to fix this before going to finish and insert?
A: First, see if the anterior teeth can be set back closer to the mandibular anterior teeth. The maxillary lip will hang lower with less lip support. The vertical dimension may be too open. I don’t care if all your measurements indicate the vertical is correct, if the patient is unhappy, the case will be a failure. So, have the patient smile broadly and mark with a lab knife, from teeth # 7-10 where the lip stops in the wax. Tell the lab to keep the incisal edge overbite the same, but lower the vertical until the gingival aspect of the teeth touch the line. The posterior teeth will need to be reset so there is not a reverse curve of spee. After the corrections are made by the laboratory, a second try-in is advised and the patient should sign off on the tooth positions before final processing of the dentures.