Narrative for implant removal

A narrative for D6100, implant removal by report, addressed to the dental claim consultant. It has blanks for the date, patient name, date of birth, member ID, and implant numbers, and a list of reasons to circle, including pain of unknown origin, numbness, mobility with significant bone loss, a fractured implant, a broken screw that cannot be retrieved, and stripped internal threading. A second list covers related procedures performed, such as a bone graft.

Complete it when submitting a claim for implant removal. Circle only the reasons documented in the chart, list the implant numbers, and attach the supporting records. The doctor should review it before it goes out.