Dr. Sam Kratchman was born and raised in New York. He received a B.S. in Biology and a D.M.D. both from Tufts University in Boston, Massachusetts. Sam then attended the University of Pennsylvania, where he received a certificate of endodontics, and currently serves as an Associate Professor of Endodontics and the Assistant Director of Graduate Endodontics, in charge of the microsurgical portion of the program. Dr. Kratchman has authored several articles and chapters on endodontics and intentional replantation for the Microsurgery in Endodontics textbook, and the Dental Clinics of North America. He also developed a patented instrument called the S Kondenser for the obturation of root canals. Both Main Line Today and Doctor of Dentistry magazines honored Dr. Kratchman as the cover story for their “Best of” issues.
There will be a brief discussion about the Endo/Implant trends in current treatment planning. Also the prevalence of cracked teeth will be discussed and the advantages of CBCT technology. Complications such as sinus involvement, treatment of otherwise hopeless teeth, and several other complex cases will be shown all involving modern endodontic techniques.

 

 

It seems like just yesterday that I was writing my 1st Presidents message pondering what I can do to make a difference? I can’t believe its almost a year and by this time next month I will no longer be your MCDS President. Oh, how the time has flown. I have enjoyed my term tremendously working closely with NJDA staff and our board members. I have gained confidence, trust and respect. I have met with so many business leaders and members from other components and learned how they conduct their business. It has helped me grow and mature individually. They all have been a great asset.
Our future at MCDS looks bright. The board unanimously approved and introduced our nominations for the 2017-2018 slate of officers. Dr. Amit Vora will be a tremendous President with his calm and cool demeanor and Dr. Genevieve Fernandes is putting together a fantastic list of speakers and topics for the scientific lectures including a full day lecture by Dr. Dennis Tarnow in October. Dr. Sanjeev Satwah is just waiting in the wings as VP. He has been involved with MCDS since the end of his residency at JFKMC and has served in the past as a liaison between RSDM and MCDS. He is still the Chair for the New Dentist committee. Dr. Antoinette Tauk is steady with her organized and attention to detail personality with a flavor of humbleness. What I am most excited about is the probability of another young blood, Dr. Mario Fiorentini, joining the ranks of these awesome Board members. He too has been involved with MCDS since the end of his residency at RWJUH and contributed at our meetings.
Please join me on April 18, 2017 to welcome this new slate of officers as they will be sworn in and inducted. This will be our last lecture until the fall as Dr. Sam Kratchman will speak on the topic of “Complications In Endodontics.” There is plans for a special finale to my Presidency year so don’t miss it :)

Editor’s Note: Business was conducted via the MCDS Google Group instead of having a physical meeting, due to snow.
President’s Report – Dr. Devang Modi
The Board unanimously approved Dr. Mario Fiorentini for Treasurer of MCDS for the upcoming year. The board was presented with a list of all the 2016 MCDS members that did NOT renew in 2017. There are currently 112 names on that list released by the NJDA. Members of the Board intend to contact these individuals and hope that some are an oversight or will renew soon. Board will report back any reason for the nonrenewals. JFK Residents will do a table presentation.
Treasurer’s Report – Dr. Sanjeev Satwah
See full report on page 3
NJDA Council Reports:
Dental Benefits – Dr. Devang Modi, Dr. Antoinette Tauk
The Council on Dental Benefits had its meeting on 2/8/17. There were many topics discussed as this was our first meeting of 2017.
CRP Statistics: Staff provided the council with cumulative statistics for January through December 30, 2016 indicating a total of 118 complaints submitted to NJDA for the year. Of that number, NJDA successfully resolved 51, 10 were for data purposes, 49 are still pending and 8 were not resolvable. Component members are encouraged to use Joan Monaco and NJDA staff as a resource for insurance claims, benefits and reimbursement issues.
Multiplan Expedited Payment: Discussed Multiplan as third party vendor for most commercial carriers that have medical component (Aetna/Horizon). They are asking you to accept reduced fee for expedited reimbursement. Fees based on 400 million occurrences across the nation, RVU (relative value units) and a conversion factor. Conversion factors for each CPT codes are based on the medium accepted reimbursement amount by physicians nationwide.
MetLife FEHB Plan Overpayments: Federal plans, Military family, etc. are advised to submit to dental before submitting to medical. Met will estimate primary FEHB benefits and pay as if they were primary, but if they identify later that there are other allowable benefits – they will seek reimbursement overpaid. Asking you to consider filing with the FEHB plan first and then to Met as secondary with FEHB voucher.
BCBS NJ Prime Therapeutics: Horizon can deny coverage based on medical necessity. Need to find what the criteria are before submitting. Prime Therapeutics is an administrator for Horizon BCBS of NJ and issues Rx benefits based on BCBS Medical necessity criteria. This was denied due to the “prior authorization program,”
United Concordia: New Dental Officer/Contract Amendments: Dr. Quinn Dufurrena is the new Chief Dental Office at United Concordia. Dr. James Bramson will retire at the end of 2017.
UCCI recently amended the UCC participating dentist agreement for NJ based on information from the NJ DOBI. “Dentist may bill member for non-covered services, which are defined as any service for which no payment is made under the applicable plan or arrangement for any reason.”
Delta EOB Examples/Medicare & Dr. Malmacher: Discussed Medicare opt-in/opt-out deadline, and various options available. Scare solicitation to get enrollment in webinar. Discussed different EOB narratives and examples. Certification on predeterminations is blatant. Carry-over max on some plans explained on EOB.
Delta Fee Decrease – Dr. Keith Libou Visit: Discussed meeting with Dr. Libou and Delta’s fees being lowered, and Delta’s policy of not providing fee schedules to providers. Members were advised to contact Delta Provider Relations and discuss dissatisfaction with the policy. If providers drop out of network, Delta will notify their patients of other providers they can see. If a provider wants to become a Delta provider after dropping out, he can only apply as PPO provider. The next council meeting is scheduled for May 17, 2017.
Peer Review – Dr. Sandy Goldstein
There was one new case assigned for mediation last month. We currently have two cases in active mediation.
Committee Reports:
Corporate Sponsorship – Dr. Ira Rosen
At the March General Membership meeting, all four of our gold sponsors will be in attendance – ZimmerBiomet, Dentsply International, Provident Bank and Techspedient. In addition, one of our bronze sponsors will be joining us again– Kuwata Pan Dent. Please join me in welcoming our sponsors and be sure to visit them and view their products.
The corporate sponsorship committee is proud to support our upcoming Continuing Education program. On Friday, October 20, 2017, MCDS is proud to bring Dr. Dennis Tarnow back to speak to us at the Pines Manor. Dr. Tarnow is a world-renowned speaker, educator and clinician in the field of dental implants. Due to the outstanding work of the MCDS Executive Board and the support of our corporate sponsors, all MCDS members will be able to spend a full day learning from Dr. Tarnow, including coffee breaks and a full buffet lunch, for the incredible member-only early registration fee of $25.00! This is the ultimate member benefit and we hope to see all of our members there.
Mentor – Dr. Nima Mir-Madjlessi
Our bi-annual OSHA program that satisfies the OSHA standard on Occupational Exposure to Blood Borne Pathogens, which is required annually for dentists and staff, will be given on June 15, 2017 at JFK Hospital in Edison NJ. Two CEU credits were awarded to the dentists & staff members attending these 2-hour seminars. These seminars are available as a member benefit of MCDS. A very big “thank you” to Dr. Devang Modi for arranging all our room accommodations for the MCDS-OSHA-Mentor programs at JFK Hospital in Edison, NJ. Please see the insert in this newsletter for additional information and registration for the Mentor program.
Respectfully Submitted,
Dr. Antoinette Tauk
Secretary

General Dentist Associate Wanted

For an established private practice in
North Brunswick, New Jersey.
The hours available are:
Wednesday, Thursday, Friday and Saturday.

This practice offers state-of-the art technology with an experienced and friendly staff in a great area. If you seek clinical autonomy, good compensation and ability to maintain a work-life balance while practicing in a friendly environment, then please email your CV to the email address below. This could be the next great next step in your dental career.

Contact: Bob Schwartz
Phone: 862-400-3223
Email: [email protected]

DENTAL OFFICE AVAILABLE TO SUBLET

Modern, high end office located in a professional building in North Brunswick available to sublet part time. Great opportunity for a new dentist startup, satellite office or specialist.
Please email inquiries to
[email protected].

Insurance Claims Problems?

Claims Resolution Service is available through the NJDA to help you resolve any dental claim issue. Please contact Dr. Joan Monaco at 732-821-9400.
This service is provided free to you as a member benefit.

General Membership Meeting Business

The slate of officers for 2017-18 was unanimously approved by a vote of the members present at the meeting. They are as follows:
President: Dr. Amit Vora, President-Elect and Education Coordinator: Genevieve Fernandes, Vice President: Sanjeev Satwah,
Secretary: Antoinette Tauk, Treasurer: Mario Fiorentini. This slate was previously unanimously approved by the Board via a Google Group vote on 3/15/17.

Provide MCDS with your email address!

As those of you who have registered your email addresses with us know, the Board is becoming more pro-active in notifying you with timely information, such as upcoming early registration deadlines, reminders about any changes in dates for the General Meetings, course reminders, etc. By having your email address, we can get such vital and timely information to you. Register by clicking here.

MCDS Newsletter Online

To receive the newsletter electronically in lieu of receiving a printed copy, please click here.
By registering, you will be able to view the newsletter about a week before it would get to you in the mail, and this will also be saving us money. You will receive an email letting you know that the new issue is available for viewing on our web site. You can also download a digital version in pdf format.

A Coding Conundrum
Let's Look at 4346
By Dr. Joan Monaco, NJDA Directory of Dental Benefits

The 2017 version of the ADA’s CDT Dental Procedure Codes contains 11 new codes, 5 revised codes and one deletion. Although there isn’t much difference between CDT 2016 and CDT 2017, the new changes could cause a delay in your claim reimbursement if your software system or staff is not up to date. One code in particular seems to be the topic of many questions so I would like to talk in depth about the new periodontal code D4346.

Before understanding the use and implications of 4346, let’s re-visit some basics regarding periodontal treatment procedures, CDT codes and how/when they should be considered. In my mind, I break down potential treatment scenarios into categories: Gingivitis, Early Periodontitis, Moderate Periodontitis and Advanced Periodontitis.

Before we get to 4346, Let’s Look At…D0110 - Prophylaxis
When a patient is scheduled for an initial comprehensive exam or check-up, the first code that comes to mind is good old D0110. The ADA defines D0110 Prophylaxis - adult as “Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.” Note, there is no distinction between supragingival or subgingival. In my mind, this would be the definitive procedure in all patients where there is no loss of attachment…which includes all forms of gingivitis.

D4355 – Full Mouth Debridement to Enable Comprehensive Evaluation and Diagnosis
Frequently, that statement is met with resistance by those that firmly believe every patient that walks in the door should not receive a prophylaxis – instead they submit a claim for D4355. I like to think of it as creative billing submissions. It’s an additional procedure they can charge for and inconvenience the patient with, by having them come back another day for an actual prophy. There are times when this is indeed indicated, and if you read the definition of the code, it is pretty self-explanatory. D4355 –Full mouth debridement to enable comprehensive evaluation and diagnosis is defined as “The gross removal of plaque and calculus that interfere with the ability of the dentist to perform a comprehensive oral evaluation. This preliminary procedure does not preclude the need for additional procedures.”

I have to ask myself…What About this Definition is it that People do not Understand? I have personally experienced this confusion when my 16-year-old daughter (who religiously reports for 6 month recall appointments) switched over to a general dentist (also a personal friend) for a new patient exam, cleaning and full mouth series. I didn’t give the visit much thought until I received the EOB from my husband’s dental carrier where I see that D4355, and FMX are billed out. WHAT? This kid had NO SUPRAGINGIVAL CALCULUS that I could see (believe me, crazy mom dentist that I am, I check at home with my mirror and explorer before the visit). And to top it off, when I asked my daughter what was actually done she said “a little scraping and no polishing” and she said she was re-appointed for the cleaning visit.
So getting back to the definition…this general dentist could not see clinically what they needed to see to perform a comprehensive exam?? I think not. I could see clinically that she had no obvious carious lesions or calculus (even lower anterior) with my home dentistry mirror and explorer…and guess what, the comprehensive exam and FMX confirmed it as well. So how does the office get reimbursed for D4355, then a D0110, comprehensive exam and fmx (at a later date) when in reality all she needed was the prophy? Well, the answer is that every carrier does it differently, but usually D4355 is auto-adjudicated through the claim system and unless it becomes a “pattern of practice,” the insurance company will pay the claim assuming the submission is legitimate.

But We Digress…On to D4355
In the words of Dr. Art Bilenker, “Oh, but I digress”…so – I see firsthand that someone I know and respect is misinterpreting the code and its use. Let’s look at it through the world according to Joan….D4355 should be used when a patient presents with so much calculus and schmutz (for lack of a better word) that your hygienist needs a jack hammer to remove the gunk so you can actually see the teeth. That’s my interpretation of D4355. So yes, if a patient presents like that and you can’t possibly see what you need to see clinically to make diagnostic decisions, then submit for the D4355 and re-appoint the patient for the D0110 and exam at a later date. The definition says “…calculus that interferes with the ability of the dentist to perform a comprehensive oral evaluation.” Oh, and by the way, that appointment should not take 15 minutes. If there is so much schmutz blocking your view, a good 30—45 minute appointment would be appropriate. I’m just saying, for those of you that subscribe to the 15 minute D4355 code submission on 16-year-old patients with no calculus…..mark my words….IT WILL CATCH UP TO YOU!

Moving on…..I would like to believe we can all make the distinction between gingivitis, early, moderate and advanced perio, but I have many claim denials and frustrated dentists that show me the opposite. I can discuss the intricacies regarding the distinct differences and what your clinical documentation should demonstrate in another rant, but I would like to address the D4346 code. So how does that come into play when we are still so confused over D4355 versus D0110?

At Last, D4346!
Well, D4346 is Scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation. “The removal of plaque, calculus and stains from supra – and subgingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingival, generalized suprabony pockets, and moderate to severe bleeding on probing. Should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.” If you note my bold highlighting, this code does make the distinction of supra and sub-gingival calculus as opposed to a D0110 where there is none.

So back to the world according to Joan
Short disclaimer, I should qualify that this is my personal opinion and not the opinion of the NJDA. D4346 is for the patients that come in with a ton of inflammation and bleeding – moderate calculus – but should respond to general scaling. For example, a college student in the middle of mid-terms or finals; a pregnant women; diabetic patient, etc. These patients report with severe inflammation but NO LOSS OF ATTACHMENT. Perhaps pseudo-pockets and bleeding on probing. That’s when you would submit D4346. Re-appoint the patient for prophy and re-evaluate the tissue. If they responded to the scaling, then perhaps all that is required is a prophy. If they didn‘t respond to the treatment, then perhaps scaling and root planing or additional debridement may be in order.

Summing It All Up
So let’s re-cap. A patient reports with some sub and supra calculus, but not generalized inflammation and bleeding. D0110 prophylaxis should be performed. If a patient reports with so much calculus you can’t see the teeth, D4355 or if a patient comes in with some supra and sub gingival calculus but also has generalized moderate inflammation and bleeding and (NO LOSS OF ATTACHMENT) then D4346 should be performed. If you see loss of attachment then you are talking early, moderate or advanced perio and D4341/4342 scaling and root planning would be indicated.