Journal of the American Academy of Craniofacial Pain

Volume 29 Number 2 | Winter 2016

AACP 32ND ANNUAL INTERNATIONAL

August 4 - 5, 2017 – Grand America Hotel – Salt Lake City, UT

CLINICAL SYMPOSIUM

TMDiary is the official journal of the America Academy of Craniofacial Pain. TMDiary is published twice yearly: Fall/Winter and Spring/Summer and is intended solely for the use of Academy members and to act as an open forum for disseminating pertinent clinical, scientific, and personal information. Letters and articles represent the view of the writer and do not necessarily represent the view of the AACP, this journal, or the editorial staff.

Comments and letters to the editor from Academy members and non-members are welcomed. Please send these items to the executive director. The editorial staff reserves the right to select articles for publication and edit same.

For more information concerning the American Academy of Craniofacial Pain please contact:

Bill Carney, Executive Director 11130 Sunrise Valley Drive | Suite 350 | Reston, VA 20191 800.322.8651 | 703.234.4142 | 703.435.4390 fax www.aacfp.org | central@aacfp.org

Mayoor Patel, DDS, MS & Edmund Liem, DDS, Editors

Jack C. Cherin, DMD, Associate Editor and Photojournalist

NOTE: The statements and opinions contained in editorials and articles in these publications are solely those of the authors and not of the AACP or of its officers, members or employees. Statements and facts contained in advertisements for products or services are the responsibility of the advertisers alone. The editors and AACP directors and officers, and employees disclaim all responsibility for facts and opinions referred to in any articles or advertisements in this or other publications by the AACP.

Table of Contents

President’s Report 3 Steven R. Olmos, DDS

Institute News 4 Terry Bennett, DMD

The Academy has a New Address 5

Report from the Australian Chapter of the AACP 5 Andrew Lee, DDS

10th Annual AACP Canada Conference 6 Edmund K.T. Liem, DDS

Content Marketing and Your Dental Practice 7 Sara Berg

Don’t Forget to Educate Your Dental Team 8 on Craniofacial Pain and TMFD Mayoor Patel, DDS, MS

OSA Patient: Understanding a Chronic 9 Disease Model Deepak Shrivastava, MD

Deleted TMD Codes & New Replacement 10 Codes Take Effect Rose Nierman

American Academy of Craniofacial Pain 11130 Sunrise Valley Drive | Suite 350 Reston, Virginia, 20191 USA P: 703.234.4142 | F: 703.435.4390 | www.aacfp.org

TM Diary | Winter 2016 3

President’s Report

It is my honor and privilege to repre-sent our Academy in this position that so many great people have served. I am very excited about our future.

I am inspired by the hard work and motivation that I see from attendance at our terrific symposium in Austin, Texas. Thank you Dr. Ed Lipskis for all

you do as our Program Chair. A wonderful meeting with education, matriculation and comradery.

I have just returned from the Canadian Chapter meeting in Vancouver and it was terrific. Thank you Dr. Edmund Liem for organizing every part of that meeting and serving as President. I am in awe of your energy.

I look forward to visiting Australia for their Annual Sympo-sium in March 17-19, 2017. Dr. Andrew Lee as President and his team have done a remarkable job in growth and quality of education they provide. Congratulations!

I would like to welcome our new Board members elected at our Summer Symposium in August. They are Dr. Joe Baba, Dr. Gary Dennington and Dr. Chris Simmons. Members you have done an outstanding job of electing a motivated group that are already contributing to our Academy.

Our Membership Chair Dr. Richard Goodfellow is working hard to increase members and member benefit. Please view his video on our Academy website and share with all you know. Our membership is growing under his direction.

Dr. Jeanne Bailey our Treasurer is working hard to find ways to increase our income retention for redirection in ways that will give our Academy a bigger voice and to serve our mem-bers. We are all very lucky to have her and we do appreciate her efforts.

Dr. Rick Light our Secretary is the person who keeps record of all of our Academies efforts. It is a position that does not get much light (sorry Rick), however his efforts are much appreciated.

Dr. Dennis Marangos is our new President-Elect. What a pleasure he is to work with. He is a tremendous contributor and our future is in great hands. He has organized the online education delivery system that we have been dreaming of for years. Please visit the website: AACPCE.com to see the array of courses that are now available through the Ameri-can Academy of Craniofacial Pain Continuing Education.

Dennis was the Chair of the Education Committee and so that position has been transferred to Dr. Joe Baba and Dr. Cameron Khuene. This Committee has tremendous respon-sibilities as it is responsible for all education for our Academy outside of our annual general meeting. This includes the AACP Institute. Dr. Terry Bennett has done a remarkable job of developing numerous courses and delivered through-out the US and Canada. He has developed a relationship with the University of North Carolina Dental School to host courses and is working with other schools. Thank you Terry. The person who has organized the delivery and is the back-bone is Dr. Stacy Cole. Stacy, thank you for the structure you bring to this huge task.

AACP Mission Statement The American Academy of Craniofacial Pain is committed to the relief of craniofacial pain, temporomandibular disor-ders and dental sleep related disorders and supporting the advancement of education, research and dissemination of knowledge and skills in these areas.

We do so in a therapeutic way as to restore hope. We are the Academy of Hope.

Our future is very bright.

Happy Holidays and a very Happy New Year!

We Are the Academy of Hope By Steven R. Olmos, DDS | AACP President

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Institute News

First of all, I want to wish all of you a very, happy holidays and hope that all of you got to enjoy it with your families. The holiday season is a very special one and we should stop and give thanks for all the blessings that each of us have.

The Institute has been busy this fall with several courses that were pre-

sented. Class 12 of the Craniofacial Pain mini residency has two sessions behind us and we have an excellent class of 20 students. Many of the students are already putting into practice some of the injection techniques that they learned and are helping their patients tremendously. It’s gratifying to see the students not only learn but practice what the instructors are teaching them. Sessions 3 and 4 will con-tinue in 2017 and the dates for Class 13 have already been selected; so watch out for them on the AACP calendar.

In September, Wes Shankland presented a great dissec-tion course in Denver. He tied together the relationships of structures involved in both sleep and TMD and the physi-ology of how they worked together. We also had Dania Tamini presented her course on Cone Beam Radiology and the anatomy that we should all consider when looking at any CBCT scan. This course was held in Atlanta and as you can see, we are trying to present courses in all parts of the US. Both these courses got rave reviews from the students and even though they were well attended, I was personally disappointed at the attendance.

The year 2017 will start the year with two different and new offerings of the Dental Sleep Mini Residency. We are collaborating with the University of North Carolina with our 3 session, 6-day course and these sessions will be held in Feb., March and April and will include several speakers from the North Carolina and Duke University arena. Enroll-ment has already gotten off to a great start and I personally

hope that this partnership will develop into a long lasting relationship. The North Carolina people that I am working with have been amazing with their ideas and marketing and this should be one of the best sleep courses that is being offered in the US. We are also offering, for the first time, the 4-day Dental Sleep Mini Residency in Toronto, ON Canada in March. This will copy the course that has been held in San Diego in the past but will feature many Canadian speakers. Henry Schein is offering much help in making this course possible and the course will be held at their facility. Both of these courses are on the web site and hopefully, you have gotten brochures and email blasts by this time. Don’t miss out on the chance to improve the knowledge in Sleep and TMD by attending these courses and hopefully, I will see you at one or the other of them.

The last course that is presently being offered is a second offering of the very successful Injection and Botox course. This will be held in Dallas at our new DoubleTree headquar-ters and again, it is on the website and also the brochures should have been mailed by the time this article is out. This is a chance to brush up on the injection techniques that many of us use daily and understand why we do each of the injections. Botox will also be discussed as an adjunctive treatment for those very difficult patients and this treat-ment has been proven very successful for that clenching and headache patient that can’t be controlled. Many of you have attended other courses that are currently being offered and if you haven’t given the Institute courses a chance for education, you may be surprised at what you can learn from the varied instructors that we have presenting.

I am always willing to listen to new course ideas, so if any-one has a burning desire to teach and have something that is new and different, please contact me with the idea and I will tell you how to proceed with many the course a reality. Again, Happy Holiday season and will see you next year.

2017 CE Agenda Highlighted by New Offerings By Terry Bennett, DMD

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The AACP, along with the ABCP and the ABCDSM, has moved its central office. The new office is located at 11130 Sunrise Valley Drive, Suite 350, Reston, VA 20191. The move was prompted by rapid growth of the Academy’s management firm, Drohan Management Group. In short, we simply ran out of space!

The new offices are more modern, roomy and efficient. Just a week after the move, the AACP Budget Committee met in the new offices and had a chance to see the upgrades. By all accounts, they were pleased with the new location, which is still just minutes from Dulles International Airport.

It’s important to note that all phone numbers and emails remain the same, so the transition caused almost no issues. It has been business as usual!

If you’re ever in the Reston, Virginia, area and would like to visit, we’d love to show you around. Just contact Executive Director Bill Carney at bcarney@drohanmgmt.com.

The Academy has a New Address

It’s now the run up to Christmas and your Committee of the Australian Chapter of the AACP has been hard at work finalizing the details for our Scientific Symposium next year in March 17th-19th 2017.

It’s been a big year for the AACP in Australia, We had our 5th Symposium in March of this year and we had over a hun-dred delegates enjoying a jam packed 3 days in Sydney on everything you needed to know about pains in the head. We also had 3 well attended Local Chapter days in May, August and October.

I would encourage all of you to try to attend these Local Chapter days. They are designed to be accessible and low cost and usually revolve around some of the practical and clinical aspects of treatment. We usually have interesting local Australian speakers from wide and diverse back-grounds and they are always interesting and useful.

The Committee’s main focus for most of this year has been on our upcoming Symposium in Sydney, on the 17th-19th March, titled “ Sleep and Pain, from Research to Reality”.

This could be the best Symposium we have held yet. I am really excited about the lineup of speakers that our Educa-tion Officer, Karen McCloy, has organized for us and the topics that she asked each of them to speak on. She has done a fabulous job and deserves congratulations and grati-tude for her dedication and work.

We have some of the best international scientists, research-ers and speakers in the world on these topics. Karen has also managed to organize some wonderful Australian speakers to complement our international presenters. You would have all received our brochure for the Symposium and I encourage all of you to read the summaries and synopses of the speakers. This should be first CE event that you register for in 2017.

We have 3 speakers who have previously presented for us at one of our earlier Symposia. We would only invite them back because they were so good that once is definitely not enough. These 3 are Proffessors Gille Lavigne, Leila Gozal and Peter Svensson. Gilles Lavigne needs no introduction to anyone who has the slightest interest in the fields of Sleep, Pain and Bruxism. He wrote the text book on it, in fact he’s

Report from the Australian Chapter of the AACPBy Andrew Lee, DDS | President, Australian Chapter, AACP

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Report from the Australian Chapter of the AACP continued

written several text books on these topics and as he so entertainingly demonstrated when he spoke for us in 2013, he is also a most engaging and dynamic speaker.

Dr. Peter Cistulli, one of Australia’s foremost clinicians and researchers in Sleep Medicine and also one of our present-ers next March, congratulated Karen when he had heard that one of the Gozals was presenting next year. He was absolutely gobsmacked when he was told that both the husband and wife team of David and Leila Gozal were going to be speaking. Professors David and Leila Gozal are abso-lute giants in the world in their fields of Sleep and Paediatric

Sleep research. We are privileged that they have both agreed to present their research and work to us next year. They are not to be missed.

I won’t go through the whole speaker list. I encourage you to look at our website or read the brochure that you would have received and I am sure that you will see the value and quality of our 2017 Symposium.

I look forward to welcoming all of you to our 6th Sympo-sium held in Sydney from the 17th-19th March 2017.

The Canadian Chapter of the AACP celebrated this year their 10th annual conference. The conference was held on November 4 -5, 2016 in Vancouver, BC.

The conference was very well attended; more than 120 have registered and this makes this the largest AACP Canada conference so far. Attendees were travelling from all over Canada and the USA. We had several repeat USA visitors that enjoy our conference program and hospitality. This year is the very first time we have decided on a new formula: a joint conference with a similar like-minded organization. We found a group that has been striving a very similar goal and that is the NAAFO (North American Academy of Facial Orthotropics) and decided to run a joint confer-ence. This decision has been a great success and similar collaboration could happen again in the future. This joint conference allows our members to hear speakers that we not always get to see and the same applies to the other group. This cooperation has also attracted attendees that are completely new to both groups, resulting in about 1/3 of potential new members.

We also had organized a pre-conference course about GOPex which stands for “good oral postures exercises”. The course was about exercises to create and enhance good oral posture which is essential to create a stable orthodontic result. This course was packed by 35 people and very well received.

This year conference was opened with a photo tribute to 10 year AACP Canada; The chapter was founded at the sum-mer AACP meeting in 2006 in Denver, CO. Coincidently the music that was chosen for the photo-tribute was “Hallelu-jah” by Leonard Cohen, the iconic Canadian composer and singer that passed away just 1 week later at the age of 82. You can view this photo-tribute at this link: https://goo.gl/hDEHHP.

The theme for the conference was: TMD, OSA & Orthodontics…..more than a structural connection! The first speaker was Dr. Brian Weeks, an ENT from San Diego who showed the importance of a proper nasal function and the minimal invasive techniques of balloon sinuplasty. He was followed by our AACP President Dr. Steven Olmos who discussed the importance of identifying the Obstructions in OSA and how to triage the treatment. The third speaker was our own medical director Dr. Deepak Shrivastava who has the ability to break down complex medical issues in for us understandable pieces. He was followed by Dr. John Remmers who shared with us the concerns and dilemmas MD’s has with OSA treatment and what kind solution he has for this. Last speaker of the day was a Critical Care Nurse: Julia Worrall. She told a personal story which lead to a call for more cooperation between the healthcare professionals. She was unaware what dentist can

10th Annual AACP Canada ConferenceBy Edmund K.T. Liem, DDS | President, AACP Canada

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10th Annual AACP Canada Conference continued

do for craniofacial and sleep disorders and she was amazed about the potential.

For the Friday evening we have organized a trip to the Museum of Anthropology followed with a dinner on site. Surely it was a very interesting visit.

Day 2 started with the one and only Prof. John Mew; he explains what he has describe more than 50 years ago the “tropic premise”. Insight in this will help us understand what the cause is of crooked teeth and obstructive sleep apnea. His son Dr. Mike Mew followed him and showed what he has seen around the world how fellow dentist are creative to bring the midface forward. Dr. Simon Wong from Melbourne, Australia shared with us the reasons why he developed the Good Oral Posture exercises. Just before lunch time we had a guest speaker: Mr. Omar Lalani; he

shared with us his compelling personal story what he has endured with his personal orthodontic treatment. He wants that the orthodontic profession pay attention to technique that could impair airway. He has started a website that is worth visiting: www.righttogrow.org.

After lunch Dr. Bill Hang showed us the future of orthodon-tics where (an improved) airway is the main goal. The last speaker, Patrick McKeown from Ireland, spoke about the Buteyko breathing technique; this a breathing technique that is developed by the late Konstantin Buteyko which, among others, treat over-breathing.

All in all, this was a successful 2.5 days filled with lots of information for everybody. All the sessions are video recorded and will be available at a later stage.

Up to the next 10 years!

You’ve completed dental school, and maybe even some advanced education courses, but what about content marketing? Throughout your years in dental school you’ve learned how to properly care for your patients and provide the right services, but you weren’t shown the importance of creating content. From educational materials to newslet-ters, it is important to add content marketing to your dental practice’s plans.

As a Writer, Editor, and Content Specialist, I work with Dr. Mayoor Patel and a variety of other dentists on creating content for their websites, newsletters, social media, and other areas of marketing. To help you gain a better under-standing of the need for content marketing, below are a few areas you should pay close attention to:

Your Website Let’s begin with your website. First, do you have a website for your practice? If you do not have a website yet, now is the time to get started. By having a website, you can reach your patients while providing educational materials. A web-site allows you to introduce yourself, your team, and your

services, while providing educational materials through website content and blog posts.

Create a welcoming website that shows your patients where you’re located, how to get in contact, and educa-tional materials that will help them make the best informed decisions about their oral health possible. The availability of an active blog also allows you to answer common questions and provide advanced information about your practice, and services offered. If you don’t have time to write weekly blog posts, don’t worry—I provide blogging services so you don’t have to worry about finding time.

Your Social Network It’s one thing to have website, but it is another to have an active social network, too. Create business pages for your practice on Twitter and Facebook for even further outreach to your patients. When searching for a dental practice, patients often go to Facebook or Twitter to see what you have to offer, and what other people are saying. Seeing that you are active on Facebook and patients love your services allow new patients to feel more comfortable about your practice.

Content Marketing and Your Dental PracticeBy Sara Berg

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Content Marketing and Your Dental Practice continued

Beyond the setup of social media channels, it is important to actively post for your patients. Whether it is an update of the practice, photos of the office, or educational articles and blogs, your patients want to remain up-to-date. With weekly blogging on your website, you automatically have something to share each week. If you need help setting up a Facebook or Twitter account, or sharing information, I can help you here, too.

Your Newsletters or Email Outreach One last area that often goes overlooked is a monthly newsletter or email marketing. By creating a mailing list, you can send weekly or monthly newsletters to your patients. A suggested topic for weekly emails might be weekly dental tips. You can also do a monthly newsletter that offers important educational information, tips, and

updates about your practice. As a dental practice that is establishing their role in craniofacial pain or TMD, it can significantly benefit your office by sending out monthly emails to keep your patients informed about these new services—it might be just what your patient needs to read to realize they have an issue at hand.

The questions and tips you can include in newsletters are limitless. Use your creativity to brainstorm important ideas that your patients should know when it comes to craniofa-cial pain, TMD, or other services. Through email marketing you can further reach your patients because a majority of patients check their emails multiple times a day.

To learn more about content marketing or to take the next step in providing these services for your practice, please feel free to contact me by visiting https://saraiceberg.com/.

So you’ve chosen to take the leap toward furthering your education by offering craniofacial pain and TMD services within your dental practice—that’s great! Since you’ve already decided to advance your education in these new ser-vices, don’t forget your dental team. It’s one thing to be fully educated in these advanced areas, but it is another to have a well-rounded dental team assisting you along the way.

Your Team: Getting your team the right education to pro-vide craniofacial pain and TMD services alongside you is just as important as your own continuing education. By educat-ing your team, you can have the necessary support needed to properly diagnose and treat your patients.

Below you will find some members of a typical dental team and how education is vital to their role in your office:

– Dental Assistant: Your assistant is your go-to person in the office, which means they should always know what is going on, and how to provide the services you offer. Bring your dental assistant to all courses you attend so they, too, can be on the same page as you.

– Dental Hygienist: Your dental hygienist interacts with patients the most, so they are often the first ones to notice symptoms of craniofacial pain, TMD, and other conditions. While joining you in various courses is important, there are also classes tailored to hygienists and their specific needs. Continuing education for hygienists will help them in ask-ing the right questions and knowing what to look out for.

– Office Manager/Billing: Even the office manager and billing coordinator need to be educated in craniofacial pain and TMD, as well as other advanced areas of dentistry. The more your office or billing manager knows about these ser-vices, the better prepared they will be in not only providing educational information for your patients, but in properly billing for services and scheduling appointments.

Once a patient likes, trusts, and believes in your entire den-tal team, you have created a patient for life. Start educating your team now.

Don’t Forget to Educate Your Dental Team on Craniofacial Pain and TMDBy Mayoor Patel, DDS, MS

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top of the latest advancements in dentistry for yourself, as well as including your team in these advanced classes.

With a well-rounded team of dental experts, you can provide your patients with the best care possible from the moment they walk into your office. From the office manager to the dental hygienist and assistant, your team needs to be on the same level of educational care, so that nothing slips through the cracks for quality patient care.

Importance of Education: The field of dental education is large and varied, as it covers a lot of different jobs. People can train as general dentists, specialists, dental hygienists, dental assistants and also as dental laboratory technicians. And, once a dental professional has qualified, they cannot rest on their laurels. The world of dentistry is always chang-ing, and at a fast pace with new technology being brought in all the time. For that reason it is important to remain on

Obstructive sleep apnea (OSA) is a chronic disease without any cure. Despite the treatment, OSA remains a relatively costly disease when compared to other chronic diseases.1 The heath care utilization is a result of both OSA itself and co-morbid conditions like obesity, hypertension, hypercho-lesterolemia, diabetes, impotence, tobacco use, ischemic heart disease. A comprehensive plan of chronic disease management is desirable in this situation to improve patient outcomes and cost containment. Many ongoing factors influence the course of OSA including ageing, weight changes, life style changes, substance use, and progression of other systemic diseases and their treatments. In addition, compliance remains a major issue in the usage of major non-invasive treatment modalities, CPAP, and oral appliance Therapy (OAT).

A population-based study discovered that a 10% weight gain predicted a 32% increase in apnea hypopnoea index (AHI) while a 10% weight loss predicted a 26% decrease in AHI. 2 Rising epidemic of obesity imposes a major demand in continued weight management of OSA patients. Patients who achieve significant weight loss after bariatric surgery, a significant percentage regain their weight.3 Chronic obesity management is required including dietary changes, exer-cise and behavioral changes. Recently published American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice is a good resource for providing medical care to the obese patients.4

Alcohol consumption and smoking are considered two modifiable risk factors for OSA. Many screening tools are available for alcohol dependency and providers are required to screen for alcohol use, discuss, and educate the patient on each follow up visit. Smoking is a known risk factor for OSA.5, 6 Health care providers are required to screen for smoking, discuss and educate OSA patients. Referral is encouraged to the special counselors and special providers to consider pharmacotherapy and regular follow up.7,8

Patients once diagnosed with OSA and treated with oral appliance therapy require regular follow up with the dentist every six months and yearly with sleep specialist. To ensure effectiveness of the treatment as well as compliance and troubleshoot problems, initial follow up visits are important. In the event that Oral appliance therapy is not tolerated, further investigation is planned to identify the underlying issues with adjustment in OAT settings, further adjustments and discussion of other confounders.

Patient with OSA need evaluation of their driving risk. Risk factors include patients having previous motor vehicle acci-dent, near-miss incident, or evidence of daytime sleepiness and diminished driving performance.

OSA meets all six criteria for chronic disease model of heath care delivery. They include 1.OSA care is linked to a health care organization or facility, 2. Need for community resources like alcohol anonymous or smoking cessation program, 3. Self-management support and training,

OSA Patient: Understanding a Chronic Disease ModelBy Deepak Shrivastava, MD

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OSA patients to show their impact on outcomes parameters. Considering OSA as a chronic disease, and the recognition of the fact that these patients require ongoing care in dental, medical, neurocognitive and public heath domains will help develop multispecialty management programs that are likely to improve compliance, early intervention, and positive life style changes as well as measurable outcomes.

4. A delivery system with planned visits like durable medi-cal equipment (DME) company and provider visits 5. Access to specialists and educational sessions like AWAKE support group and 6. A electronic medical record software system that gives regular alerts for follow up checks.9,10

A variety of chronic disease management models is avail-able for adaptation. However, there is insufficient data in

Bibliography:

1. AlGhanim N, Comondore VR, Fleetham J, Marra CA, Ayas NT. The economic impact of obstructive sleep apnea. Lung 2008;186(1):7e12.

2. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. J Am Med Assoc 2000;284(23):3015e21.

3. Odom, J., Zalesin, K.C., Washington, T.L. et al. OBES SURG (2010) 20: 349.

4. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLO-GISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITY 2016; ENDO-CRINE PRACTICE.22; (Suppl 3) July 2016

5. Berry RB, Bonnet MH, Light RW. Effect of ethanol on the arousal response to airway occlusion during sleep in normal subjects. Am Rev Respir Dis 1992;145(2 Pt 1):445e52.

6. Scanlan MF, Roebuck T, Little PJ, Redman JR, Naughton MT. Effect of moderate alcohol upon obstructive sleep apnoea. Eur Respir J 2000;16(5):909e13.

7. Wetter DW, Young TB, Bidwell TR, Badr MS, Palta M. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 1994; 154(19): 2219e24.

8. Kashyap R, Hock LM, Bowman TJ. Higher prevalence of smoking in patients diagnosed as having obstructive sleep apnea. Sleep Breath 2001;5(4):167e72

9. Hroscikoski MC, Solberg LI, Sperl-Hillen JM, Harper PG, McGrail MP, Crabtree BF. Challenges of change: a quali-tative study of chronic care model implementation. Ann Fam Med 2006;4(4):317e26.

10. Kreindler S. Lifting the burden of chronic disease: what has worked? What hasn’t? what’s next? Healthc Q 2009;12(2):30e40.

Typically, when I find out about important medical codes being deleted, my first instinct is to hit the panic button – however this time it’s not the case. The major ICD-10 diag-nosis codes that were deleted were replaced with new codes.

What has changed? Revised ICD-10 codes for TMJ disorders went into effect on October 1, 2016.

TMJ codes were rewritten to indicate laterality; ICD-10 codes specified laterality for other parts of the body and are now that requirement is in place for the TMJ.

Injury codes specify Initial, Subsequent or Sequela; Injury codes now need to show when an encounter is initial, subsequent or a sequela. To determine which one applies, put yourself in the patient’s shoes. For example, if the visit is

Deleted TMD Codes & New Replacement Codes Take EffectBy Rose Nierman | Founder & CEO Nierman Practice Management

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a patient’s initial encounter for active treatment of an injury, it would be coded as an initial encounter. If the patient previously received active treatment for this condition, it may be a subsequent encounter. ICD-10-CM says the term sequela is “for use for complications or conditions that arise as a direct result of an injury, such as scar formation after an injury; “The scars are sequelae of the injury.” In other words, sequela are the late effects of an injury.

Many of the deleted and revised ICD-10 codes are listed below:

Deleted TMD ICD-10 codes:

– M26.60 TMJ disorder, unspecified

– M26.61 Adhesions and ankylosis of TMJ

– M26.62 Arthralgia of TMJ

– M26.63 Articular disc disorder of TMJ

Added TMD ICD-10 codes to indicate laterality:

– M26.611 Adhesions and ankylosis of right TMJ

– M26.612 Adhesions and ankylosis of left TMJ

– M26.613 Adhesions and ankylosis of bilateral TMJ

– M26.621 Arthralgia of right TMJ

– M26.622 Arthralgia of left TMJ

– M26.623 Arthralgia of bilateral TMJ

– M26.631 Articular disc disorder of right TMJ

– M26.632 Articular disc disorder of left TMJ

– M26.633 Articular disc disorder of bilateral TMJ

Added Sprain of Jaw ICD-10 codes:

– S03.41XA Sprain of jaw, right side, initial encounter

– S03.41XD Sprain of jaw, right side, subsequent encounter

– S03.41XS Sprain of jaw, right side, sequela

– S03.42XA Sprain of jaw, left side, initial encounter

– S03.42XD Sprain of jaw, left side, subsequent encounter

– S03.42XS Sprain of jaw, left side, sequela

– S03.43XA Sprain of jaw, bilateral, initial encounter

– S03.43XD Sprain of jaw, bilateral, subsequent encounter

Added Dislocation of jaw ICD-10 codes:

– S03.01XA Dislocation of jaw, right side, initial encounter

– S03.01XD Dislocation of jaw, right side, subsequent encounter

– S03.01XS Dislocation of jaw, right side, sequela

– S03.02XA Dislocation of jaw, left side, initial encounter

– S03.02XD Dislocation of jaw, left side, subsequent encounter

– S03.02XS Dislocation of jaw, left side, sequela

– S03.03XA Dislocation of jaw, bilateral, initial encounter

– S03.03XD Dislocation of jaw, bilateral, subsequent encounter

With over 37 states mandating TMJ coverage and most medi-cal insurance covering sleep apnea appliances, put away that panic button and begin updating your codes - so that your patients can receive maximum medical reimbursement.

Rose Nierman, RDH, Founder of Nierman Practice Management is the creator of DentalWriter™ and CrossCode™ software and CE for TMJ and Dental Sleep Medicine treatment. Nierman’s CrossCoding; Successful Medical Insurance for Dentists course is the premier Dental to Medical Billing Course in North America. Contact Rose at www.Dentalwriter.com or at 1-800-879-6468.

Deleted TMD Codes & New Replacement Codes Take Effect continued

Approved PACE Program ProviderFAGD/MAGD Credit

Approval does not imply acceptance by a state orprovincial board of dentistry or AGD endorsement

3/1/2015 to 2/28/2018

RondeauSeminars

The Leader in Dental Continuing Education

InternetCourse Available

For more information,visit our website

InternetCourse Available

For more information,visit our website

• Expand Your Practice • Increase Your Income • Revitalize Your Interest in Dentistry

BROCK RONDEAU,D.D.S., I.B.O., D.A.B.C.P., D-A.C.S.D.D., D.A.B.D.S.M., D.A.B.C.D.S.M.

DIPLOMATE INTERNATIONAL BOARD OF ORTHODONTICSDIPLOMATE AMERICAN BOARD OF CRANIOFACIAL PAINDIPLOMATE-ACADEMY OF CLINICAL SLEEP DISORDERS DISCIPLINESDIPLOMATE AMERICAN BOARD OF DENTAL SLEEP MEDICINEDIPLOMATE AMERICAN BOARD OF CRANIOFACIAL DENTAL SLEEP MEDICINE

1-877-372-7625r o n d e a u s e m i n a r s . c o m

Rondeau Seminars reserves the right to cancel or reschedule any portion of the seminars due toinsufficient enrollment or scheduling conflicts. Cancellation policy in effect. Plus taxes where applicable.

Chicago, IL.......................................January 20 & 21, 2017 Orange County, CA .....................March 10 & 11, 2017Toronto, ON................................................ April 7 & 8, 2017

2017 Course Dates & Locations

Dates and hotels are subject to changeCE credits 14 hours lecture, case diagnosis at the course

Vancouver, BC .............................December 2 & 3, 2016 Dallas, TX......................................December 9 & 10, 2016Miami, FL ....................................March 31 & April 1, 2017

2016 - 2017 Course Dates & Locations

Dates and hotels are subject to changeCE credits 14 hours lecture

The Dentist’s Role in Snoring & Sleep Apnea

Diagnosis & Treatment of TMD

Why You Should Take This CourseIn this course, you will gain basic step-by-step information on snoring and sleep apnea. Dr. Rondeau will provide you with a clear understanding of this disorder by showing 14 cases start to finish, including full records, diagnosis and treatment.

Why You Should Take This CourseWhen patients have structural problems (anterior displaced discs) within the TM joint, then the dentist must become

involved to rectify this problem by using splint therapy to obtain a more stable jaw relationship. It has been estimated that as many as 80% of headaches are related to anterior displaced discs and clenching and bruxing.

Course Content • Sleep Apnea Symptoms and Causes • Sleep Examinations and Forms • Hospital Sleep Studies (Polysomnogram) • ARES Sleep Study • Different Sleep Cycles • Summary of Sleep Disorders • CPAP - Continuous Positive Air Pressure • Surgical Solutions for Sleep Apnea • Comparison of Different Oral Appliances • References and Articles • Marketing Your Sleep Practice • Sample Reports to Sleep Specialists, MD's, Dentists, and E.N.T.'s • How to Bill Insurance Companies for Oral Appliances

Course Fee: $1,095 per Doctor or $495 per Sta� (includes extensive course manual)

Course ContentNumerous clinical cases with full records will be shown

on how to �nd the correct maxillo-mandibular relationship.• Phase I - Diagnostic Splint Therapy

• Phase II - Orthodontic Case Finishing

Dentists have the prime responsibility to diagnose and treat this common disorder. TM disorders are progressive and worsen over time; therefore, just like orthodontics, it is imperative that the problem be treated as early as possible. Dentists

treating patients for snoring and sleep apnea need to have a clear understanding of this disorder to properly treat their patients using oral appliances.

Course Fee: $1,095 per Doctor or $495 per Sta� (includes extensive course manual)