Practice

Billing for sterile consumables
The costs for sterile material are included in the operating costs of the practice model and may not be charged separately. If additional material can be charged for a specific item, this is either explicitly stated in the service catalog or is explicitly stated in the introductory text of a chapter.
(Source: SSO-Internum 5/2023)

Sealing fissures
When sealing fissures (number 4.5820) the etching of tooth enamel (number 4.5800) may be charged additionally. Only for extended fissure sealing (number 4.5830) both numbers 4.5800 and 4.5810 can be charged.
(Source: SSO-Internum 5/2023)

General anesthesia for dental procedures
The KLV has been supplemented by the new Article 19b. The insurance covers the costs of general anesthesia for dental treatments according to the KLV Articles 17-19a, if these are not possible without general anesthesia.
In addition, general anesthesia is covered if the treatment is not possible due to a severe mental or physical disability of the insured person. The dental services remain at the expense of the patient.
(Source: SSO-Internum 6/2020)

Billing of the sleep apnea splint (KLV 19e)
The snore splint can be billed with the number 4.8170 as an analogy item. According to KLV articles 17f and 19e, the health insurer covers the costs of dental treatment. The laboratory costs are billed according to the new technician tariff and reimbursed separately with a maximum of CHF 730 (MiGeL ch. 14).
On July 1, 2014, the letter e: “sleep apnea syndrome” was added to Article 19 KLV and the sleep apnea splint was included in the MiGeL list of means and objects. The following conditions must be met for a KLV compulsory benefit:
– Diagnosis of sleep apnea syndrome must be confirmed by polysomnography
– a pulmonologist or an SSSSC-certified center for sleep medicine prescribe the protrusion orthosis
– healthy or rehabilitated dentition; no free-end situation, no periodontally weakened dentition, etc.
– effectiveness of the orthosis must be checked at least once by polysomnography
– the dentist monitors the patient regarding side effects caused by wearing the splint
If necessary, the costs for the snoring splint are alternatively covered by the patient’s private supplementary insurance for medical aids in addition to the KVG. Also in this case, have the patient referred in writing by the pulmonologist or general practitioner.
(Source: SSO Internum 6/2014 and 6/2020)

Bite splint
As an alternative to the expensive Michigan splint, a soft splint in the lower jaw can be used to protect the teeth in cases of bruxism. This is manufactured using a deep-drawing process and is billed with the number 4.8180. This tariff item includes impressions of both jaws and a bite registration. This splint supports the entire occlusion evenly and can also be worn comfortably during the day.
(Source: SSO Internum 6/2023)

Billing the Michigan splint at the private rate
The Michigan splint is billed at code 4.1770. This includes: Impression taking, impression taking of the opposing jaw, preparation of the laboratory order, delivery to the patient including initial grinding, instruction of the patient. In addition, the bite registration (centric registration) and, if necessary, the facebow transfer can be charged.
The Federal Office of Public Health (FOPH) informed the SSO in a letter dated June 21, 2011, that the application for inclusion of the Michigan splint (dental temporomandibular joint orthosis) in the list of products and articles (MiGeL) was rejected. The federal authorities do not consider the effectiveness, appropriateness and economic efficiency of treatment with a Michigan splint to be given. The studies submitted were insufficient and not sufficiently conclusive.
The costs of the Michigan splint may be covered by a private supplementary insurance policy for medical aids taken out by the patient in addition to the KVG.
(Source: SSO-Internum 3/2011, SSO-Internum 5/2011; SSO-Internum 6/2012)

Duty of care – guarantee of success
In its ruling of February 9, 2007 (BGE 133 III122), the Federal Supreme Court commented in detail on the question of the physician’s liability and on the legal qualification of the medical order. The following is quoted from this:
> According to Art. 398, para. 2 OR, the contractor (doctor) is liable for faithful and careful execution of the business assigned to him. The special nature of the medical art is to be taken into account, in that the doctor has to work with his knowledge and ability towards a desired success, but this does not mean that he must bring this about or even guarantee it, because the success as such is not part of the medical duty. The scope of the physician’s duty of care is based on objective criteria. Account must be taken of the circumstances of the individual case, namely the nature of the intervention or treatment, the associated risks, the scope of discretion, the resources and time available to the physician, as well as his training and ability. Violation of his or her duty of care, possibly referred to as “malpractice,” constitutes, in the legal sense, a failure to perform or a poor performance of the contract. If the patient suffers damage as a result and if it can be assumed that the doctor was at fault, the patient is entitled to compensation. It is up to the injured party to prove the breach of the doctor’s fault. According to the law of contracts, the dentist can be prosecuted for malpractice within 10 years (limitation period). The period begins to run from the completion of treatment.
> The treatment of the patient requires the patient’s consent, which is derived from the patient’s right to personal freedom and physical integrity. The physician who operates on a patient without information and without consent is liable for the damage, regardless of whether his conduct involves a breach of his duty as an agent. Interference with bodily integrity requires justification, and this must be provided by the patient. However, in order for the patient to give consent, he/she must be informed by the physician in clear and understandable terms about the diagnosis, the therapy, the prospects as well as alternatives of the proposed treatment, the risks of the operation, the chances of recovery and the possible development of the disease as well as the financial consequences. It is up to the physician to prove that he or she has adequately informed the patient and that the patient has consented to the proposed treatment. It can also be assumed, in individual cases, that the patient would hypothetically have given his consent if he had been duly informed.
(Source: SSO Internum 1/2008)

Informing the patient
According to §35 of the Health Law of the Canton of Zug, dentists must inform their patients, without being asked to do so, with due diligence and in an understandable and appropriate manner about
a) the examinations and the diagnoses
b) the proposed as well as other possible treatments;
c) the risks and side effects;
d) probable development of the state of health with or without the proposed treatment;
e) the cost implications.
Record in the patient’s file, in key words, the date and content of the educational discussion with the patient. This education is not credible if it was not billed to fee code 4011. If the patient has acknowledged this invoice item, this can also be regarded as proof that the clarification took place. Insufficient clarification is already considered a violation of the duty of care ergo as malpractice. (Source: SSO Internum 4/2000 and 6/2014).
In any case, the information should be provided orally. The form provided here for preoperative information on treatment risks in the mandible (PDF) can facilitate the documentation of the information provided in liability cases after surgical interventions.

Further information on informing the patient: SDJ Vol 109: 8/1999 (PDF)

Managing the medical history
The dentist is obliged to keep a medical history. This is based, on the one hand, on the treatment order he or she receives from the patient and, on the other hand, on the public-law obligation as laid down in the Health Act. The records must be complete and true and may not be subsequently altered. Such manipulations constitute a criminal offense of falsification of documents. The medical records shall be kept for 20 years for reasons of preservation of evidence.
The patient has the right to inspect the medical records at any time. This does not apply to personal notes made by the physician. However, this term is very narrowly defined. If these personal notes serve the purpose of treatment or if they can also be inspected by auxiliary persons, they are considered part of the medical history and can be inspected by the patient.
The original medical record should not be released. However, the physician must make copies if requested and explain them if necessary. If, in spite of everything, the original of the medical history is handed over, the patient must in any case obtain a written release from both the obligation to retain it and the patient must waive any liability claims against the dentist.
In the event of a transfer of practice, medical records cannot simply be handed over to the successor. The predecessor and successor should best inform the patients in a joint letter and/or advertisement about the impending change of ownership and the planned handover of the records. Patients must then be given a reasonable period of time within which they can request the handover of the medical records in return for confirmation. It must also be pointed out in the letter that if the patient fails to do so within the specified period, it will be assumed that the patient agrees to the transfer of the records to the successor.
(Source: SSO Internum 2/2009; see also Health Law Canton Zug § 36)

Professional liability insurance
Professional liability insurance is a prerequisite for practising as a dentist in one’s own professional responsibility. Basically, all damages caused by the violation of the duty of care are insured.
Subsequent cover from the liability insurance for 20 years must be explicitly requested from the insurer in order to provide appropriate cover for liability in the event of personal injury (Art. 128 OR).
(Source: SSO Internum 6/2019)

ZSR-Number
The ZSR-Number facilitates billing between service providers and KVG insurers. It must be applied for by the service provider and is regularly checked by SASIS AG. SASIS AG charges the service provider a fee of CHF 100 + VAT every five years.
The legitimacy of this fee was checked by the SSO together with the FMH and also found to be correct by the price supervisor.
(Source: SSO Internum 6/2019)