CDC Clinical Operations & Patient Care 3 — Questions and Answers
Question 1: A dental consultant is evaluating a claim for a full-mouth series of radiographs taken 10 months after a previous full-mouth series. Under most dental plan guidelines, what is the most likely outcome?
- Approve, as radiographs are always medically necessary
- Deny, as most plans require a minimum interval of 3–5 years between full-mouth series for adults (Correct answer)
- Approve if the dentist documents a new chief complaint
- Deny unless the patient has periodontal disease Stage III or higher
Correct answer: Deny, as most plans require a minimum interval of 3–5 years between full-mouth series for adults
Most dental plans establish minimum intervals (typically 3–5 years) between full-mouth radiographic series for adults without high caries risk, making a 10-month repeat non-covered.
Question 2: Which aseptic technique error poses the greatest cross-contamination risk during a dental procedure?
- Failing to change gloves between patients (Correct answer)
- Not replacing the plastic barrier on the light handle between patients
- Using the same cup of disinfectant wipes for multiple operatories
- Wearing the same mask for consecutive patients in the same appointment block
Correct answer: Failing to change gloves between patients
Failing to change gloves between patients allows direct transfer of patient blood and saliva, representing the highest cross-contamination risk.
Question 3: A patient with a documented penicillin allergy requires antibiotic prophylaxis before a dental procedure. Which antibiotic is the standard AHA alternative?
- Amoxicillin 2g orally 1 hour before
- Clindamycin 600 mg orally 1 hour before (Correct answer)
- Metronidazole 500 mg orally 1 hour before
- Azithromycin 500 mg orally 1 hour before
Correct answer: Clindamycin 600 mg orally 1 hour before
The American Heart Association recommends clindamycin 600 mg as the primary alternative for patients with penicillin allergy requiring infective endocarditis prophylaxis.
Question 4: When reviewing treatment records for medical necessity, which criterion most strongly supports the necessity of periodontal surgery?
- Patient reports sensitivity to cold beverages
- Documented probing depths of 5–6 mm with no response to scaling and root planing after 4–6 weeks (Correct answer)
- Presence of calculus visible on radiographs
- Patient preference for surgery over repeated cleanings
Correct answer: Documented probing depths of 5–6 mm with no response to scaling and root planing after 4–6 weeks
Persistent probing depths of 5–6+ mm that fail to respond to non-surgical therapy after adequate healing time is the primary clinical criterion supporting surgical necessity.
Question 5: A dental office is transitioning to electronic health records (EHR). Under HIPAA, which safeguard is mandatory for protecting electronic protected health information (ePHI)?
- Printing all records daily as physical backup
- Implementing access controls, audit controls, and encryption for ePHI (Correct answer)
- Storing all ePHI exclusively on cloud servers outside the US
- Requiring patients to consent to EHR use before treatment
Correct answer: Implementing access controls, audit controls, and encryption for ePHI
HIPAA's Security Rule mandates administrative, physical, and technical safeguards including access controls, audit controls, and encryption to protect ePHI.
Question 6: During a clinical audit, a consultant notes that a dentist routinely bills a comprehensive exam (D0150) at every recall visit. What is the most appropriate finding?
- This is acceptable if the patient hasn't been seen in over a year
- This constitutes upcoding; recall visits should typically be billed as periodic oral evaluations (D0120) (Correct answer)
- Comprehensive exams are always appropriate as they are more thorough
- This is acceptable if the dentist spends more than 30 minutes per patient
Correct answer: This constitutes upcoding; recall visits should typically be billed as periodic oral evaluations (D0120)
Billing D0150 (comprehensive exam) for established-patient recall visits instead of D0120 (periodic oral evaluation) is upcoding, which constitutes fraudulent billing.
Question 7: Which of the following is the correct protocol for handling a needle-stick injury in a dental office?
- Immediately squeeze the wound to express blood, wash with soap and water, report to the employer, and seek medical evaluation (Correct answer)
- Apply a tourniquet proximal to the injury site and go to the emergency room
- Wash the wound with betadine, apply a bandage, and monitor for 30 days
- Complete an incident report only if the source patient is known to be HIV positive
Correct answer: Immediately squeeze the wound to express blood, wash with soap and water, report to the employer, and seek medical evaluation
The correct post-exposure protocol is to allow the wound to bleed briefly, wash thoroughly with soap and water, report to the employer, and seek prompt medical evaluation for post-exposure prophylaxis assessment.
CDC Clinical Operations & Patient Care 3
A dental consultant is evaluating a claim for a full-mouth series of radiographs taken 10 months after a previous full-mouth series.
Under most dental plan guidelines, what is the most likely outcome?