The 12th Edition of the Australian Schedule of Dental Services and Glossary has just been released.
The schedule is published by the Australian Dental Association (ADA) will take effect from 1 April 2017.
The decision to release another edition so soon after the last was prompted by sustained concern about the deletion of items 281 and 282 from the the periodontal section of the 11th edition.
According to the ADA, this concern triggered broad consultation with the affiliates, health funds and individual members who played a key role in its formulation. This has led to the creation of additional item numbers to describe active and non-surgical periodontal treatment, as well as changes to the descriptors of other item numbers in the periodontal section of the schedule.
The reasoning behind the deletion of item numbers 281 and 282
Initial concerns about the change were raised at the time of the publication of the 11th edition at the start of last year.
At that time there was a communication published in which Dr Martin Webb, ADA Schedule and Third Party Committee member, explained that the reasoning behind the decision to delete the items had been based on the following factors;
An erratic and inconsistent array of services provided under 281 and 282 between providers and even between the same provider to different patients
- • An understanding that no service deemed carried out under 281 or 282 is not already accommodated elsewhere in the schedule
- • Some providers have been billing 2 x 281 and even 4 x 281 at the same visit
- • Many auxiliary dental providers carry out the 281 and 282 creating a scope of practice issue with ADPs wanting expanded scope
- • Particularly with reference to 282 when addressed specifically most practitioners admit scale and clean and some root planing is done and little else
- • In the 10th edition, scale and clean item numbers descriptors were amended to allow root planing to be done on same visit, as specialist feedback has been that not all teeth needed root planing
- • An insistence from some Private Health Insurers (PHI) and specialists that 281 and 282 are specialist only services which is against ADA policy
- • 281 and 282 are also amongst the most commonly misinterpreted or abused item numbers in the Schedule.
Dr Webb then proceeded to explain: “A fundamental principle of the Schedule and Glossary is that its main aim is the most accurate description of the outcomes of treatment performed by practitioners.
“It is accepted that changes in billing procedures and fees may be required as a result of changes to item numbers or descriptions as each new edition of the Schedule is published. The ADA does not determine item numbers based on PHI rebates, nor can it influence the business rules adopted by PHI determining the way in which item numbers are rebated.”
Similarly, Terry Pitsikas, Chairman ADA Inc Schedule and Third Party Committee, underlined the ADA’s reasoning as follows;
“What precipitated the deletions and become the issue at hand is that not every patient receives the identical service[s] under item 281 and 282. For example, a patient with six remaining teeth cannot possibly get the same services provided as someone with 28 teeth. Patients who have 28 teeth may not need the same number of teeth root planed – one may require only six teeth root planed and the remainder may need scaling and another may require 16 teeth root planed and another may require all 28 teeth. Some may require desensitisation of some or all teeth. Each patient is receiving different services yet all have an account raised as 281 or 282. It has become increasingly more apparent that the variation is even greater between practices i.e. no two practices provide exactly the same services, yet in all these examples items 281 and 282 have been used in the past. There can be no fairer billing system than billing for the service provided. Fair for both provider and recipient of the service.”
Hopefully this clears up any confusion on the matter but if you require further clarification of the changes please contact the ADA directly by email.[box]
What is the Australian Schedule of Dental Services and Glossary?
The is the definitive coding system for items and clinical procedures. Each dental treatment assigned a three-digit code for easy identification and treatment planning.
Please note that the schedule for the Child Dental Benefits Schedule, while based on this publication, bear the prefix 88 i.e. a comprehensive exam in The Australian Schedule of Dental Services and Glossary will be listed as 011 but under the CDBS, it will be 88011.[/box]