Status codes are not something a credit management consultant would normally write about.  However, we have been doing some detailed testing of a new credit, collection, and embezzlement control module I am designing for a computer company and in the process have discovered dozens of examples of practices using improper procedure codes and improper status codes.  I have spoken with many dozens of doctors over the years who commented that their performance has suffered due to improper status codes and to many others, including lots of our clients, whose improper procedure codes have made it impossible to accurately track many critical aspects of practice performance.  To many doctors this issue may seem pretty benign, but the damage caused by improper posting of the procedures done and patients’ status codes being incorrect is far from benign.

Consider the following:  Just a few weeks ago I spoke with a client whose Phase II case starts had declined by 47% from the same period a year earlier.  That decline cost the practice more than $160,000 in lost production (and revenue!).  A bit of investigation found that an employee had been routinely changing the status code of finished Phase I patients to that of “Retention,” causing those patients to no longer show up as “between phase” recall patients so they did not show up as a patient needing an appointment.

Another practice had chairside assistants posting the procedure codes on patients seen in the clinic (a common practice) but these chairsides had not been properly trained and every time they bonded a bracket or delivered some Aligners they were using procedure codes that were only to be used for new case starts.  They could not figure out why they always had more case starts than they had exams!

Yet another doctor mentioned that one of his Treatment Coordinators was purposely changing the status codes of Pending patients from Pending to Inactive because she “didn’t like doing follow-up work.”  (“Pending” patients are new patients and recall patients who have had treatment diagnosed but who have not yet committed to start.)  She knew the doctor looked at the list of Pending patients to check on the quantity and quality of the follow-up the Treatment Coordinators were doing on those patients so by changing the status codes, the patients disappeared from the list.  The lack of proper follow-up of these patients cost this doctor somewhere between 15 and 20 case starts!

Each of these three doctors believed, until we showed them otherwise, that their practice statistics were accurate and that they could count on database searches and other reports to give them accurate information about their practice well-being.

These practices and each of the many other practices that have learned of performance decline related to having patients “lost” in their computer system all had one shared problem – none did annual chart audits!  Many in fact did not even know what a chart audit was.

In 1980 having a computer in the dental/orthodontic practice was almost unheard of.  Everybody had paper charts and those paper charts had color coding systems to identify the status of a given patient.  Routine chart audits were virtually mandatory in those days to ensure a chart had not been lost and to ensure the patient status was properly identified.  Chart audits were normally a fun day for the team because they were done on a non-patient day.  The entire team came to the practice in their sweat shirts and blue jeans.  Some sat on the floor going through the charts.  Others were in the chart filing areas pulling the charts from the stacks, every one of them, and feeding the charts to the staff on the floor.  The doctor bought the pizza and soda at lunchtime and helped out until the audit was complete.

Then, of course, computers came on the scene and practices somehow came to believe that chart audits were no longer necessary and their zillion dollar computer could somehow keep proper track of their patients.  That thinking created the problems I mentioned above.

The necessity of regular (at least annual) chart audits has not diminished!  There exists no way of ensuring that your status codes are correct and, therefore, that your recall/observation/pending systems are properly functional without a periodic cross-check (chart audit) comparing all (observation, recall, pending, active, retention, between phase, etc.) patient clinical records with the digital “status” assigned that patient within your system.  Even in an average size practice, the cost of having even 10% of your patients with improper statuses is many thousands of dollars a year in lost revenue.