Pre-Orthodontic Treatment Examination to Monitor Growth and Development Template

Pre-orthodontic treatment examination.

RMH: Medical history reviewed/updates

Chief complaint: Chief complaint
Age: Age
Dentition stage: Dentition stage

Ortho records support: Radiographs/photos ordered by treating dentist and taken; scans/models
Last dental visit/outstanding treatment: Date and untreated restorative/perio needs
Malocclusion details: Class I/II/III, overbite/overjet/crossbite/crowding/esthetic concerns
Treatment plan details: Limited/comprehensive, appliance type, estimated duration, anticipated outcome
Retention plan: Fixed/removable retainers, wear schedule, follow-up

Clinical examination: Clinical examination
Extraoral: Extraoral
Profile: Profile
Facial symmetry: Facial symmetry
TMJ evaluation: TMJ evaluation

Intraoral: Intraoral
Oral hygiene: Oral hygiene
Periodontal status: Periodontal status
Angle classification: Angle classification
Overjet: Overjet
Overbite: Overbite
Crowding: Crowding
Spacing: Spacing
Crossbite: Crossbite

Records obtained: Records obtained
Photographs.
Impressions/scans.
Radiographs: Radiographs taken/reviewed and findings

Treatment plan discussed: Plan/options reviewed.
Options presented.
Duration estimated.
Fees reviewed.

NV: Next visit

Documentation requirements

D8660 is documented as a growth-and-development monitoring exam, not a comprehensive evaluation. The note must demonstrate that the visit was clinical (vs records-only) and that a deliberate timing decision was made — start treatment, continue observation, or refer.

• Medical history review and update — meds, conditions, allergies, growth-relevant systemic factors (asthma / allergies and mouth-breathing pattern, endocrine or syndromic conditions affecting craniofacial growth, ADHD medications affecting bruxism/clenching). Pediatric growth context matters; "no changes" is acceptable but should be written.
• Chief complaint / parent concern — in the patient's or caregiver's own words. "Mom is worried about crowding" is a legitimate complaint; document it.
• Age and dentition stage — chronological age and the patient's current stage (primary, early mixed, late mixed, early permanent, permanent). Dentition stage drives the timing decision and is the single most important data point on a D8660 note.
• Eruption sequence and timing — which permanent teeth are present, expected, delayed, or ectopic. Compare to age-norms; flag ectopic canines, missing laterals, retained primaries, ankylosis. This is the growth in "growth and development."
• Skeletal and dental relationship findings — Angle classification (or "developing Class I/II/III"), overjet, overbite, crossbite (anterior/posterior, unilateral/bilateral), open bite, midline deviation, crowding, spacing. Patient-specific values, not "WNL."
• Facial / profile / TMJ assessment — symmetry, profile (straight/convex/concave), lip competence, mentalis strain, TMJ sounds or limited opening, masticatory muscle palpation. Brief but documented.
• Habits and airway — digit sucking, tongue thrust, mouth breathing, lip biting, bruxism. AAO and AAPD both flag habit identification at the pre-treatment exam as a documentation expectation.
• Periodontal and oral hygiene status — pre-ortho hygiene baseline; any gingivitis, calculus, or recession that needs to be addressed before banding.
• Outstanding restorative or perio needs — what must be resolved before active ortho can start. This is what gates the timing decision and is a high-yield audit item; "patient must complete restorative before band-up" is the kind of note that defends the visit.
• Imaging reviewed — pano, ceph, BWs, or photographs reviewed today. The films themselves (if exposed today) are billed under D0330 / D0340 / D0350 / D0210 / D0270 etc. — D8660 is not bundled with imaging codes. If a pano was exposed, document indication and findings.
• Timing decision — explicit. Three valid outcomes: (1) start treatment now (proceed to records and case presentation; do not bill D8660 if the same visit initiates active treatment), (2) continue observation with an interval and the specific finding being monitored, or (3) refer (to orthodontist, surgeon, or other specialist). The audit-defensible D8660 note states which of the three was chosen and why.
• Treatment plan discussion — what was reviewed with the family — limited vs interceptive vs comprehensive options if treatment is recommended, appliance possibilities, estimated duration, retention implications, and fee discussion if relevant. This is what makes the visit substantively pre-orthodontic and not a generic recall.
• Photographs or scans, if taken — note specifically and bill under their own codes (D0350, D0470). D8660 alone implies no records were captured today.
• Provider signature and any auxiliary operator initials.

Default-normal templating ("dentition stage WNL, no concerns, recall 6 months") is the most common D8660 documentation weakness. Auditors interpret a D8660 note that reads identically to every other D8660 in the practice as evidence that the visit was either a generic recall (downgrade to D0120) or a marketing touchpoint (downgrade to no charge). Patient-specific findings about eruption, skeletal pattern, or the specific finding being monitored are what make the note defensible.

Common denial reasons

The most common reasons D8660 is denied, downgraded, or recouped:

• No orthodontic rider — by far the most common cause. Many dental plans do not include orthodontic benefits at all; D8660 is denied as non-covered. Verify ortho coverage before billing.
• Bundled into the case fee — patient subsequently started active treatment with the same provider, and the carrier retroactively bundles the D8660 into the global D8080 / D8090 fee. Submitting D8660 within 30-60 days of active treatment initiation increases bundling risk.
• Same-day conflict with D8080-D8090 — D8660 billed alongside an active treatment code on the same DOS. Only the active treatment code pays.
• Same-day conflict with D9310 — billed for the same provider as D9310; the two are mutually exclusive on the same DOS.
• Default-normal documentation — the note reads identically to every other D8660 in the practice, with no patient-specific eruption, skeletal, or monitored-finding detail. Auditors downgrade to D0120 or deny.
• Adult patient (post-growth) — D8660 is specifically a growth-and-development code; many carriers deny when the patient's chronological age and dentition stage indicate completed growth. For adult ortho consultations, most carriers expect D9310.
• Frequency exceeded — second or third D8660 within a benefit year on a plan that limits to one. Carriers measure to the day.
• No documented orthodontic indication — the note doesn't identify a specific malocclusion, eruption concern, or skeletal pattern being monitored. Without an indication, the carrier reads the visit as a generic pediatric recall and downgrades to D0120.
• Missing prior authorization (Medicaid) — most state Medicaid programs and Medicaid MCOs require prior auth for D8660 with a Salzmann or HLD score documented; submitting without auth results in denial.
• Records-only visit miscoded as D8660 — D8660 is the exam; the records (D0330 / D0340 / D0350 / D0470) are separate. A "records day" with no clinical exam is not a D8660.

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