Narrative Support suggestions for Dental

by  Christine Taxin
February 25th, 2016

Suggestions for narrative support for use in Box 19 CMS-1500 and Box 35 of the ADA Dental Claim Form

Narrative Support Choices for Consideration:

-Certain periodontal bacteria may be locally invasive, cause tissue destruction, invade host cells and enter the blood stream. Possible introduction into the bloodstream may complicate certain systemic situations such as cardiovascular disease, diabetes, preterm and low birth weight babies and other systems

-Current evidence suggests that diabetes mellitus DM is associated with an increased prevalence and severity of gingivitis and periodontitis. Periodontitis may increase the risk for worsening glycemic control in diabetic patients, as well as increasing the risk for diabetic complications. The resulting increase levels of inflammation can result in impairments in the body’s ability to manage blood sugar levels. Reference: Diabetes Mellitus and Periodontal Diseases: Mealey, Oates; J. Periodontology 2006.

-Certain periodontal bacteria may be locally invasive, cause tissue destruction, invade host cells and enter the blood stream. Possible introduction into the bloodstream may complicate certain systemic situations such as cardiovascular disease, diabetes, preterm and low birth weight babies and other systems

-Research has connected C-reactive protein and other cytokines and chemokines to periodontal disease. The literature shows that gum disease is a significant cause of elevations in CRP levels.

-Current evidence suggests that diabetes mellitus DM is associated with an increased prevalence and severity of gingivitis and periodontitis. Periodontitis may increase the risk for worsening glycemic control in diabetic patients, as well as increasing the risk for diabetic complications. The resulting increase levels of inflammation can result in impairments in the body’s ability to manage blood sugar levels. Reference: Diabetes Mellitus and Periodontal Diseases: Mealey, Oates; J. Periodontology 2006.

-Hormonal changes and pregnancy gingivitis requires aggressive treatment as research has shown that periodontal disease may be significantly related to preterm low birth weight. Reference: Periodontal Therapy May Reduce the Incidence of Preterm Birth and Low Birth Weight Infants: Journal of Periodontology, 2007, Vol. 78 No. 5.

-Studies find a direct association between cardiovascular disease and periodontal bacteria. Even small amounts of an inflammatory stimulus can provoke a substantial amount of C-reactive protein (CRP) production which then circulates throughout the body in the bloodstream. Periodontal disease is a primary cause of inflammation in the body and may be predictive of heart disease. References: Moise Devarieus, MD, PhD, Columbia University; NIH News; April 6, 2006; Conclusion: “…older adults who have higher proportions of four periodontal disease-­‐causing bacteria (A.a., P.g., T.f., T.d.) inhabiting their mouths also tend to have thicker carotid arteries, a strong predictor of stroke and heart attack”

is a year old with a suspected diagnosis of due to the following symptoms and clinical findings.

1. Z85 Personal history of malignant neoplasm

2. Z67 Personal history of other diseases and conditions

NOTE: Use one of the periodontal codes and back up with a medical code that describes patient’s health history: i.e. Heart, Diabetic, Organ Issues or any other issues.

These symptoms, as well as the examination are indicative of . The only way to confirm a diagnosis of is to perform this test.

These codes are not to be used as primary example: Z80 family history of primary malignant neoplasm

to treat the patient appropriately. An accurate diagnosis provides the following benefits to the patient:

i.e. List what the outcome of treatment with Oral DNA as a tool that helps with diagnostics and Treatment.

i.e. Patient has a medical issue (for example-diabetes, heart disease, auto immune disease) may pose additional risk from the infection thru the oral cavity. The lab test allows for knowing type of infection present and customizing the treatment.

There are as many as 80 types of autoimmune diseases. Many of them have similar symptoms, which makes them very difficult to diagnose. It’s also possible to have more than one at the same time. Autoimmune diseases usually fluctuate between periods of remission (little or no symptoms) and flare-ups (worsening symptoms). Currently, treatment for autoimmune diseases focuses on relieving symptoms because there is no curative therapy.

Autoimmune diseases often run in families, and 75 percent of those affected are women, according to AARDA. African Americans, Hispanics, and Native Americans also have an increased risk of developing an autoimmune disease.

The following are some of the more common autoimmune diseases: Look for these when you are doing your health history.

Laser Assisted Periodontal Therapy

Since implants are not routine dental care, file implant claims with medical first, if the prevailing diagnosis is medical in nature. We`re seeing many states passing laws that do not allow jawbone and/or jaw joint treatment to be excluded if bones and joints in other parts of the body are covered. Know your state laws so you can include for treatment of implants or TMD

Can medications affect my dental treatment?

Yes, medications can impact your dental health. In fact, each time you visit your dentist, be sure to give him or her complete, up-to-date information about any recent hospitalizations or surgery, recent illnesses and/or any changes in your health since your last visit, and any changes in any medications you may be taking.

Regarding medications, be sure to write down and bring with you a list of the names of current drugs you are taking, their dosages, and frequency of use. Include any over-the-counter products you may be using, as well as any herbal products and supplements. All of these issues will need to be considered by your dentist in order to devise a safe and effective treatment plan for you.

What is Molecular testing?

Molecular genetic testing is performed to identify a specific mutation of the CYP2C19 gene located on chromosome 10, responsible for encoding the cytochrome P450, family 2, subfamily C, polypeptide 19. This complex polypeptide is part of a mixed function oxidase system that metabolizes xenobiotics (compounds foreign to the body such as drugs and toxins) and also bioactivates and synthesizes substances such as cholesterol, steroids, and other lipids. A large phenotypical variability factor is present due to genetic polymorphism. The common variants are categorized as normal-fully functional (*1), decreased or non- functioning (*2, *3), decreased or partial-functioning (*4, *5, *6, *7, *8), or increased-partial functioning (*17). Genetic testing may be ordered for individuals undergoing certain drug therapy (antiepileptics, proton pump inhibitors, antidepressants) to identify gene mutations which alter the metabolism of the compound leading to an adverse drug response or effect.

Writing a medical necessity:

Guidelines are developed for selected therapeutic or diagnostic services found to be safe, but proven effective in a limited, defined population of patients or clinical circumstances. They include clinical coverage criteria based on current literature review, consultation that provide the diagnostic tests to back conditions that provide a medical necessity diagnosis.. Medical necessity guidelines are updated annually, or more frequently if new evidence becomes available that suggests needed revisions.

When using any of the Medical Necessity Treatments always include:

1. periodontal pockets (before and after results)

2. Periodontal Pathogens (before and after results)

3. periodontal bleeding (before and after results)

4. Lower CRP If it was high

5. Lower HbA1c if it was high

Whenever sending a letter of medical necessity try to include a reference or material that backs your treatment.

Narrative Support suggestions for Dental. (2016, February 25). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/narrative-support-suggestions-for-dental-28308.html

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