dental narrative

Sourced answer

A dental claim narrative is the short written statement submitted with a claim that reports what the chart already documents: the diagnosis, the charted findings and their measurements, the radiographic findings, what was done, and what is attached. Payers ask for one when the code carries published clinical criteria a reviewer has to verify — scaling and root planing, crowns, and core buildups are the three highest-volume examples — and the narrative is read against the attachments, not instead of them. The published criteria differ by payer, and none of the documents read here sets a pocket depth: Aetna's DCPB041 carries no millimetre figure at all and keys on six-point charting with bleeding on probing plus radiographic bone loss and root-surface calculus, Delta Dental Ins. criteria require a periapical rather than a panoramic radiograph within one year of a crown preparation, and Cigna's PERIO-16 bars payment where the same office retreats a quadrant inside 24 months. A narrative that states more than the chart documents is worse than a denial, because payer reviewers and auditors compare the two.