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Section I - Oral Health Examination and Diagnosis

Published on 05 April 2024

1-(a) Extensive Clinical Examination

  • The extensive clinical examination now has a minimum recall period of 12 months.
  • Depending on each patient’s dental history and clinical assessment, the recall frequency can be set at 12, 18 or 24 months.
  • It cannot be claimed again by the same dentist for the same patient within 11 complete calendar months. Item 1-(a) can be claimed within 11 complete calendar months by an Orthodontist or by a GDP, if submitted as part of an orthodontic claim.
  • Dentists are not expected to extend the recall after the first new patient examination, as there will be no known history of patient behaviours. If, in your clinical opinion, the patient is a high risk for dental disease or other oral health issues, then earlier recall may be appropriate using the item 1-(b) Review Examination, at intervals determined by the clinical evaluation.
  • Dentists are not expected to complete a full 6-point pocket chart at this examination. If, following a BPE recording of 3 or 4 and/or interdental bone loss, the practitioner determines that the patient requires further periodontal assessment then this would be completed and claimed under item 2(c) Periodontal Assessment and Treatment.
  • If a patient presents with a complaint or emergency at examination appointment 1-(a) or 1-(b) that was not expected, item 1-(c) Unscheduled Care Assessment and Treatment can additionally be claimed but must be submitted on a separate claim. 1-(c) can only be claimed if there are no other items of treatment that can be claimed to deal with the unexpected complaint or emergency.
  • There is no need to cancel or re-arrange patients who were seen in the 6 months prior to 1 November.
  • Where the recall interval for a patient will no longer be 6 months, information should be clearly communicated to the patient outlining the factors that have determined this recall period in order to alleviate concern.

1-(b) Review Examination

  • A review examination under item 1-(b) can be claimed when risk factors have been identified that require an additional appointment to allow for review between examinations, at a time outwith an open course of treatment.
  • The clinical examples listed under item 1-(b) are not exhaustive. A claim must be clinically justified, and the justification recorded in the patients records.
  • There is no time bar to item 1-(b), however, it cannot be claimed as part of an open treatment plan which includes a 1-(a) Extensive Clinical Examination. For example:
    • if at a 1-(a) Examination, a suspicious lesion is identified as well as a need for a filling, the dentist might need to see the patient to review the suspicious lesion sooner than the filling appointment.
    • In that case, the dentist could claim a 1b review exam whilst the course of treatment for the filling is still open, but they would do this as a separate claim.
  • Item 1-(b) can be claimed with item 2-(a) Enhanced Preventive Advice and Treatment (including Childsmile). To claim item 2-(a), 2 complete calendar months must have passed since the last item 2-(a) was claimed.

1-(c) Unscheduled Care Assessment and Treatment

  • This item 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. 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 lesions;
    • TMJ dysfunction;
    • temporary dressings;
    • recementing crowns;
    • any other scenario for which there is no other code that can be claimed.
  • Item 1-(c) must be claimed on its own. 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.
  • If a patient is seen as an emergency and the full root canal course of treatment cannot be started at that appointment, but the dentist needs to drain the root canal, do a pulp extirpation, or incise an abscess, as a palliative for a patient in pain until they can be seen for a routine appointment to undertake the course of treatment, then a 1-(c) could be claimed for the unscheduled care appointment. Once the patient comes back to start the course of treatment then item 3-(f), (g), or (h) could be claimed (as appropriate) for the routine treatment. The 1-(c) should be submitted as a separate claim.
  • Item 1-(c) cannot be claimed for the arrest of haemorrhage at the same appointment as item 5-(a) Extraction, 5-(b) Surgical Extraction or 5-(c) Advanced Surgical Dentistry. However, it can be claimed if a patient returns due to further bleeding for an unscheduled appointment later on the same day.

1-(d) Intraoral Radiograph

  • This item is claimed for all intraoral radiographs, their assessment and reporting. The fee is per radiograph.
  • Clinical discretion is required as per IR(ME)R guidance. There is no restriction on the number of radiographs, as long as there is clinical justification.

1-(e) Extraoral Radiograph

  • This item is claimed for all extraoral radiographs, their assessment and reporting and the fee is per radiograph.
  • Clinical discretion is required as per IR(ME)R guidance. There is no restriction on the number of radiographs, as long as there is clinical justification.

1-(f) Study Models (per set)

  • This item can be claimed for a single set of study casts or digital study models.
  • Photographs of study models are now routinely requested by Practitioner Services; therefore, duplicate study models cannot be claimed.
  • Item 1-(f) cannot be claimed for a patient more than once in any 11 complete calendar months. Where in connection with Orthodontic treatment, item 1-(f) can be claimed up to twice per course of treatment.