Claim for date of service

A narrative for scaling and root planing all four quadrants in a single visit. It describes a patient with generalized bone loss, heavy plaque and calculus, generalized bleeding on probing, and sensitivity with recession. It explains that high-risk medical issues made a single visit the only practical way to complete treatment and that the procedure was medically necessary.

Send it when a carrier questions four quadrants of SRP on the same date of service. The billing team should rewrite the clinical description and the medical reason to match the patient’s chart, and attach charting and x-rays. Have the doctor review the final narrative before it goes out.

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Claim for date of service Downloadable forms 1 .pdf
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