Infection control - to fee or not?

Oct. 1, 1999
A few years ago, I addressed the issue of infection-control costs and insurance coverage in this column. Ten years have passed since the OSHA Guidelines for Infection Control evolved into U.S. law - the Bloodborne Pathogen Standard.

Carol Tekavec, RDH

A few years ago, I addressed the issue of infection-control costs and insurance coverage in this column. Ten years have passed since the OSHA Guidelines for Infection Control evolved into U.S. law - the Bloodborne Pathogen Standard.

Infection-control issues have caused a huge change in the daily practice of dentistry. Where few dental personnel wore protective- barrier clothing, now face masks, eye protection, gloves, and scrub clothes are the rule. Where treatment rooms once featured countertops full of gadgets and paraphernalia, now cleared and covered spaces are expected. Where "cold sterilization" was used for nonautoclavable items, now single-use disposables are employed.

Infection control is a necessary and significant expense in today`s dental practices, with labor and supply costs for some procedures - such as handpiece-sterilization - continuing to escalate. (Handpieces still do not hold up well during sterilization, resulting in the need for frequent repair or replacement. Trained dental-staff salaries also are rising.)

According to the March 1999 issue of the CRA Newsletter, the actual cost per patient (single clinician) for infection-control products is $9.31. If an assistant is utilized, .87 must be added. Using these figures and assuming 15 patients per day, five days per week, 48 weeks per year; we see that the annual cost of infection-control products for one dentist and one assistant amounts to $36,648! This figure is startling, especially when taking into consideration what additional clinicians (either dentists or hygienists) and staff time and salaries add to the equation.

While sterilization procedures and products are a requisite part of every dental practice, they typically are not covered by third-party insurers. Traditional insurance carriers, as well as most HMOs and PPOs, consider infection-control issues to be the dentist`s responsibility and a part of the cost of doing business. While it is true that sterilization activities are definitely a cost of doing business, finding the funds to pay for the expense is difficult.

Raising prices to cover increased costs is the norm for nonhealth-care businesses. In the dental field, raising fees - and how the fees are framed - can be a bit more complicated. Historically, patients have not been accustomed to paying "extra" for sterilization costs, and they generally are resistant to higher procedure fees. Nevertheless, dentists today typically face either raising all fees across the board or instituting infection-control charges to defray these tremendous expenses.

If the dentist has decided to charge separately for infection control, patients need to be informed prior to instituting the fee. A good rule is to send out letters explaining the fee at least two months in advance. The letter should detail some of the procedures that are used and describe the fee as a cost for a sterile pack set-up. (Call Stepping Stones to Success for a complimentary, sample infection-control letter. Ask for Letter IC #1.)

Dentists who have agreed to contracts linked to their fee schedules - such as Delta Plan dentists - usually will not be able to balance-bill patients for a separate fee without violating these contracts. Likewise, dentists participating in an HMO- or PPO-contract network may be restricted from charging for infection control.

Nonparticipating dentists, who assist patients in receiving their benefits by filing traditional insurance claims for them, may attempt to elicit an infection-control benefit. They frequently use a self-inking stamp on claim forms stating, "Please include the following sterile-pack fee(s) with the completed procedures listed on this claim." A Code 09999-Unspecified Adjunctive Procedure, by Report, may be used with the fee. Because the ADA does not advocate a separate sterilization code and fee, there is no designated ADA code for this.

Infection-control costs are expensive. Paying for the expense is an issue that each dentist must decide, philosophically, how to deal with.

Carol Tekavec, RDH, is the author of two insurance-coding manuals, co-designer of a dental chart, and a national lecturer with the ADA Seminar Series. Contact her at (800) 548-2164 or at

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