Washington Dental Service encourages expanded use of the "comments" or "notes" section with specific, detailed clinical written narratives. These can often replace X-rays. If additional documentation is needed, i.e., an X-ray, Washington Dental Service will request it with a claim facsimile.
Listed here are some common descriptions and examples. You will need to abbreviate to accommodate your space needs. A complete list is available in our abbreviations for common clinical narratives section.
Crowns and buildups
Periodontal procedures
Crowns and buildups
They should include a written narrative that is detailed, specific, and clinical. Detail the surfaces of the prior restoration. Note the areas of decay. If tooth structure is missing, indicate the specific location. If it is missing, has it fractured off or is it missing and been replaced with restorative material? Be specific to the tooth in question, not generic to the overall need.
The Clinical Review Department needs three basic pieces of information before making a benefit determination:
- What is the existing restoration? Since space is a consideration, the shortest word we could think of is "prior."
- Why does this tooth need a crown? Is there recurrent decay? If so, describe its specific location. If tooth structure has broken off, be sure to state this. If you simply use the word "broken" or "fractured," the Clinical Review team can't tell if you mean there is a fracture line or the tooth has actually broken.
- Are there any symptoms? Certainly, half the clinical crown may be missing and the patient may feel no pain, but if there are symptoms, it is important to communicate that information.
A good narrative might be "#30 prior MODB, new ML decay, DB cusp fx off, h&c sens." Insufficient narratives might be "massive amalgam failure, needs crown, large amalgam that undermines cusps, or failing or defective restoration." You will need to abbreviate to meet your space needs.
Periodontal procedures
Periodontal charts are required for many periodontal procedures. A current (within one year of treatment date) perio chart is needed for all surgical procedures and site-specific therapy.
Please be sure to include the provider's name, patient's name, and subscriber's Social Security number on the periodontal chart, and be sure the full date of the perio readings is noted. Also, please note that red ink does not fax.
Additional Information :
Abbreviations for Common Clinical Narratives
Procedure Codes Requiring Attachments