• Sarah Beth Herman

The Basics of Dental Insurance Claims

Part 1: Narratives and Attachments


To say this training was a labor of love is NO JOKE! I am so excited to share with you the best tips for getting your claims paid and a couple of tips and tricks we have found helpful over the years. (PLUS insurance company-specific requirements).


This hot topic is big and we never want content that takes more than 10 minutes to learn so, here is part ONE. Come back for part two soon.


First, dental billing is waaaayyyyy different than medical billing. The coding and sending of claims is a unique process. It requires specific attachments, narratives, and information not readily needed on medical claims. Dental coding is based on Current Dental Terminology codes which are governed by the American Dental Association. Each year, the ADA provides code updates, revisions, deletions, and more. Staying up to date with these will be the first step to ensuring your claims are always submitted properly.


Most dentists do not readily outsource their dental billing and coding procedures and we highly recommend this. Oftentimes, we see tiny breaks in processes of narratives, attachments, and claim submissions which can be avoided with just a few tweaks. Dental billing is a position that should be maintained by a specific position in the office rather than a blanket job for everyone to have a hand in. This training will provide your dental office with those very tweaks needed to improve claims and close the revenue cycle much faster.


Narratives + Attachments


Let's break this down by category and what you need to submit with claims.


You might be like me and find that our doctors do not always put a clinical note in that helps us get a claim paid. So, we are going to help you with some templates you can use. No, we don't guarantee anything however if clinical notes are sparse, these templates can work wonders. Always check with your owner before implementing anything you find here.



Alrighty... let's go...


Osseous Surgery:

Attachments: Intraoral photos if possible

Narrative: Necessary to detoxify the root surface and to prevent further bone loss.


4263 +/or 4265 Bone Graft Replacement:

Attachments: Intraoral photos if possible

Narrative:

Necessary to potentiate new attachment and to promote bone regeneration.


4341/4342 SRP- Scaling and Root Planing:

Attachments: FMS (Full Mouth Series) and Periodontal Charting/Perio Chart)

FMX and PERIO CHART attached.

Narrative: Scaling and Root Planing necessary to remove subgingival microbiota both alive microorganisms and dead to prevent further bone loss.


Optional Narrative: The patient has BOB, inflammation, unattached gingiva, with puffing interdental papilla, 5mm pockets in each quad or higher, sub and supra calc with tartar, poor OH. Needed due to gingival migration and bone loss. The patient presents heavy deposits and severe gingivitis. To treat patients needed to be anesthetized for a through S/RP. Radiographs show loss of crestal bone and to prevent further bone loss and attachment S/RP was diagnosed to which the patient agreed to treat.


4355 Full Mouth Debridement:

Attachments: FMS + Periodontal Charting)

Narrative: Full Mouth Debridement necessary to remove heavy build-up of plaque and calculus in order to perform a comprehensive examination in the future.


D4910 Periodontal Maintenance Treatment:

Attachments: Periodontal Charting/Perio Chart

Narrative: For CIGNA AND METLIFE (mandatory documentation): Include the SPR Hx(history) as narrative.

Ex: SPR done on (mm/dd/yyyy) at UR and LR.


Gingivectomy:

Attachments: Intraoral photos if possible

Narrative: Gingivectomy is necessary due to excision of the soft tissue wall surrounding a gum pocket in [Teeth #'s].


Inlay/Onlay (Code varies by material type):

Attachments: pre-op x-ray and post op x-ray

Narrative: Multiple fractures cusps, decay/recurrent decay, existing failing restoration minimally invasive procedure performed. Favorable prognosis and the patient has no further symptoms.


2740 Crown (Code varies by material type):

Attachments: pre-op and post-op x-ray

Narrative: Indicate if it is an initial placement or a replacement.

Initial placement or existing crown replacement [date] . (SEAT DATE NOT PREP DATE).

For replacement: Improper/poorly fitting EXISTING crown open margins, recurrent decay, the tooth requires full coverage support and favorable prognosis ….pt has no symptoms. Prior placement on [date].


2931/ 2930 -Stainless Steel Crown/SSC:

Attachments: pre-op and post-op x-ray

Narrative: Stainless steel crown on #_____ to restore the tooth from decay for longer-term effectiveness in preventing recurrent caries.


More on Crowns...


Crown due to decay:

Attachments: pre-op and post-op x-ray

Narrative: [Tooth #] has been destroyed by caries/fracture and requires crown restoration.


Crown with core build-up due to composite failed:

Attachments: pre-op and post-op x-ray

Narrative: Initial placement of a crown on [Tooth #] due to large old composite filling that is broken & recurrent decay. <50% natural tooth left. A build-up & crown is necessary to properly restore the tooth.


Crown with core build-up due to amalgam failed:

Attachments: pre-op and post-op x-ray

Narrative: Initial placement of a crown on [Tooth #] due to a large old amalgam filling that is broken & recurrent decay. <50% natural tooth left. A build-up & crown is necessary to properly restore the tooth.


Crown for Implant:

Attachments: pre-op and post-op x-ray

Narrative: [Tooth #] was extracted on mm/dd/yyyy. A surgical implant placed to replace the missing tooth on mm/dd/yyyy. Implant crown and custom abutment were placed to restore chewing function in the arch and to retain the integrity of the bone and facial structures.


Crown Lengthening:

Attachments: PA x-ray and BW x-ray

Narrative: Crown lengthening needed on [Tooth #] due to improper biological width. Without the procedure, the crown margin would have been placed too close to the bone.


Redo Crown/Core Build-up:

Attachments: pre-op and post-op x-ray

Narrative: [Tooth #] date of original placement was mm/dd/yyyy. Needs build-up and new crown restoration due to excessive decay and/or margin opening.


Veneer

Attachments: pre-op and post-op x-ray

Narrative: Large missing or damaged Enamel, or incisal, facial surfaces require coverage due to lack of support/structure, the only alternative would be a crown, DDS diagnosed least invasive procedure. Favorable prognosis and the patient has no further symptoms.


Bridge

Attachments: pre-op and post-op x-ray

Narrative: Bridge prepped site [Tooth #] and [Tooth #] was extracted on mm/dd/yyyy or (cognitively missing). To preserve the site and occlusal plane. Favorable prognosis and the patient has no further symptoms.

(The wing or retainer is dental code D6548 for porcelain. The pontic tooth is dental code D6245 for porcelain.)


Root Canal Tx (Endodontic Therapy): Attachments: pre-op and post-op x-ray

Narrative: Gross decay into the nerve and Root Canal performed unto the pulp and apex of the tooth, all decay removed, build up space will be required. Favorable prognosis and the patient has no further symptoms.



Core Build-up after Root Canal:

Attachments: pre-op and post-op x-ray

Narrative: Build-up required due to previous root canal therapy and tooth structure loss upon removal of decay. Build-up performed to restore occlusal plane and successful final restoration support. Favorable prognosis and the patient has no further symptoms.



Extraction:

Attachments: PA x-ray and BW x-ray

Narrative: Due to Gross Decay [Tooth #] required extraction to preserve sight and surrounding teeth. Favorable prognosis and the patient has no further symptoms. Extraction site to be restored at a later date.


Extraction of Wisdom Teeth (1, 16, 17, 32):

Attachments: Panoramic x-ray

Narrative: Extraction of wisdom teeth number(s) 1,16,17 and 32 due to the patient is having pain/swelling. Teeth are difficult to clean - preventive measures to avoid serious problems in the future.


Bone Graft:

Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray

Narrative: Bone graft place at site [Tooth #] to preserve the site and occlusal planes for future restoration. Favorable prognosis and the patient has no symptoms.


Extraction and Bone Graft Placement:

Attachments: PA x-ray and BW x-ray

Narrative: [Tooth #] extracted due to extensive decay and non-restorability. Bone graft needed for ridge preservation for future restoration.


Extraction of Primary Tooth:

Attachments: PA x-ray +/or BW x-ray

Narrative: Over-retained [Tooth #] causing inflammation of the gingiva


Membrane:

Attachments: Intraoral photos if possible

Narrative: Barrier use to protect and promote ridge preservation and success of the graft site.


Frenulectomy:

Attachments: Intraoral photos if possible

Narrative: Frenectomy performed increases the range of motion of the tongue and will allow the child to position the tongue normally in the palate. This can help with chewing, swallowing, and speech.



6010 Implant:

Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray + date tooth # was extracted.

Narrative: Implant placed at site [Tooth #] of which was extracted on mm/dd/yyy.

To preserve the site and occlusal plane for future restoration with favorable prognosis. The procedure was medically necessary for patient to chew and masticate food properly. Favorable prognosis and the patient has no symptoms.


Abutment:

Attachments: PA x-ray +/or BW x-ray

Narrative: Custom abutment [Tooth #] placed to restore chewing function in the arch and to retain the integrity of the bone and facial structures.



Denture:

Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray

Narrative: Denture on [Teeth #'s] or Maxillary or Mandibular for the replacement of missing teeth necessary for pt to chew and masticate food properly. [Teeth #'s] extracted on mm/dd/yyyy. ***If replacement denture include the initial date of delivery for prior denture(s).


5820 Interim Partial Denture:

Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray

Narrative: Interim partial denture needed to replace [Teeth #'s]. The patient plans to get an implant placed in the future and the interim partial denture is intended to be in place for the next 12 months. [Teeth #'s] extracted on mm/dd/yyyy.



9920 Behavior Management:

Narrative: The patient is uncooperative and difficult to manage resulting in dental staff providing additional time, skill, and/or assistance to render treatment.





9230 Analgesia:

Narrative: Analgesia needed to reduce anxiety.


Night/Occlusal Guard:

Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray

Narrative: Acute bruxism and occlusal wear with head, neck, and jaw pain. Occlusal guard diagnosed with favorable prognosis.


1999 PPE:

Narrative: PPE per levels required by the CDC for transmission-based precautions



ORAL CAVITY CODE GUIDE (used for coding on Dental Insurance Claim Forms)

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