Further Clarifications

1-(b) Review Examination (for periodontal treatment only)

This is when a Dentist identifies clinical risk factors that require additional review between examinations, at a time outwith an open course of treatment.

A dentist should record in the patients notes that they have prescribed the 1-(b) review examination to be carried out by the therapist or hygienist reviewing only the risk factor prescribed and recorded.

The therapist or hygienist cannot carry out any additional/new treatment needs that weren't prescribed to them, instead bringing that treatment need to the attention of the dentist.

1-(c) Unscheduled Care

Item 1-(c), for unscheduled care assessment and treatment, is for use when a patient attends an unscheduled appointment as an emergency or has an acute condition and there is no other code in Determination I which can be claimed (except items 1-(d), 1-(e) or 8- which can be claimed alongside item 1-(c) if required).

The clinical examples listed under item 1-(c) are not exhaustive, and it can be claimed for other clinically appropriate reasons, which should be recorded in the patients records, for example, managing acute conditions; TMJ dysfunction; temporary dressings; recementing crowns; or any other scenario for which there is no other code that can be claimed.

Item 1-(c) must be claimed on its own, with the exception of item 8- (Domiciliary Visit and Recalled Attendance) and any associated radiographs (items1-(d) and 1-(e)) - which can be included in the same claim. It can be claimed in addition to another examination/treatment item if unscheduled treatment is also required when a patient attends the practice, but the 1-(c) must be submitted as a separate claim.

Observations are not required when claiming for item 1-(c).

For Orthodontists

We have recently had a number of enquiries regarding orthodontists claiming 1-(c) Unscheduled care assessment and treatment.

The Scottish Government have clarified that the item 32 fee is inclusive of all maintenance of the appliance during active treatment and item 1-(c) may not be claimed additionally by the same dentist for this purpose. A fee for unscheduled care in relation to a patient undergoing active orthodontic care and treatment under item 1-(c) may only be claimed by a contractor at another location (subject to the same dentist rule).

Item 3 - Posterior restoration involving resin

The new SDR permits the restoration of posterior teeth (including the occlusal surface) using composite resin, where this is being provided for functional, rather than aesthetic reasons. Practitioners may claim this under items 3-(a) to 3-(c), but cannot claim the posterior composite supplement (item 3-(e)), in the circumstances below:

• when there is not enough tooth remaining to provide adequate retention for an amalgam restoration, or
• for tooth wear restorations that include the occlusal surface.

Please note, however, that from 1 April 2024, this composite supplement can be claimed for the above mentioned scenarios according to the latest SDR (Amendment 163).

4-(h) Recementing of a Resin Retained Bridge

Previously, SDR Amendment 162 had indicated that this was a tooth specific item, however the item should be non-tooth specific as the fee is per bridge. SDR Amendment 163 has amended this, and tooth information is now not required for item 4-(h) for claims with an acceptance date on or after 1 April 2024.

For claims with an acceptance date prior to 1 April 2024, a workaround has been adopted to ensure appropriate payments are made and that patient charges are calculated accurately.

For the workaround, item 4-(h) must still be claimed as tooth specific; chart this against only one of the bridge units. D01801 should be claimed (to represent the recement of a single bridge) and one tooth code provided. If you select D01802 incorrectly, there is a risk the amount the patient is asked to pay is incorrect as they would be paying too much.

If you submit more than one tooth code, in order to prevent overpayment, we are automatically adjusting the payment until the workaround is no longer required. In those cases practices may need to reconcile the patient charge with the patient if necessary.

If we have adjusted the claim, you will see the following message in your eschedule report (Item of Service Adjustments): “Failed a maximum item rule. Replaced by D01801.”

Any future change will be communicated by way of a revised SDR. PSD and your Practice Management System will then be updated to reflect the revised SDR for the date when the item change comes into effect.