Periodic Orthodontic Treatment Visit Template

Periodic orthodontic treatment visit.

RMH: Medical history reviewed/updates

Treatment phase: Treatment phase
Visit number: Visit number

Evaluation:
Progress assessed.
Oral hygiene evaluated.
Appliance condition checked.
Tooth movement noted.

Treatment performed: Treatment performed
Wire change.
Elastic change.
Chain placement.
Bracket repositioning.
Appliance adjustment.

Patient compliance: Patient compliance
Elastic wear.
Oral hygiene.
Dietary restrictions.

Instructions: Instructions reviewed.

NV: Next visit

Ortho progress support: Appliance status, adjustments/repairs, tooth movement response
Compliance/OH: Wear compliance, hygiene, diet, elastics/aligner compliance
Treatment modifications/complications: Changes to plan, breakage, discomfort, complications or none

Documentation requirements

Ortho documentation is judged on progress narrative continuity more than on isolated visit detail. A defensible D8670 note ties today's visit to the case plan and to the prior visit, so a third-party reviewer can reconstruct the trajectory of treatment from the chart alone.

• Medical history review and update — meds, conditions, allergies. Pediatric and adolescent patients should have growth-spurt status, asthma medications, and any new medications (especially bisphosphonates, which contraindicate further tooth movement) flagged. New medications in adult ortho patients can change tooth-movement biology and are a frequent miss in chart audits.
• Treatment phase / visit number — where in the case plan today's visit sits. The case plan documented at D8080 / D8090 should map to a sequence (initial leveling, working phase, finishing, retention prep). State the phase and the cumulative visit number; this is the single most useful audit-defensibility line.
• Time in treatment — months since case start. Carriers paying on banded schedules use this to validate that the case is progressing on the originally projected timeline; cases that drift far past the projected end often trigger requests for updated treatment-plan narratives.
• Progress assessment — explicit comparison to the prior visit. Tooth movement observed (which teeth, in which direction), space closure progress, rotation correction, leveling progress, midline correction. Generic "treatment progressing as planned" without specifics is the most common D8670 documentation weakness.
• Oral hygiene evaluation — plaque around brackets, decalcification (white spot lesions), gingival inflammation. Ortho patients are a high-risk caries population; carriers and state boards expect explicit OH documentation at every visit.
• Appliance condition — bracket status (intact, loose, debonded), wire status (intact, distorted, end protruding), elastic/chain integrity, aligner fit and tracking, attachment integrity. Note specific teeth when issues exist.
• Treatment performed today — the actual procedures. Wire size and type if changed (e.g., ".016 NiTi → .018 stainless steel"), elastic configuration if changed (e.g., "Class II elastics 3/16 6 oz starting today"), chain placement and segments, bracket reposition by tooth, IPR by interproximal site and amount, aligner number delivered (e.g., "delivered aligners 11-15 of 30"), refinement scan taken if applicable.
• Patient compliance assessment — elastic wear (per patient self-report and clinical signs of compliance), aligner wear hours, oral hygiene effort, dietary compliance (no hard/sticky/chewy foods on fixed appliances; aligner-out for eating), missed-appointment pattern. Compliance is the highest-yield variable for case timeline; document it patient-specifically.
• Patient-specific instructions — what was reviewed today, tied to the appliance change or compliance issue. "Reinforced elastic wear 22 hr/day," "Demonstrated proxabrush use around brackets," "Reviewed aligner tray-change schedule," etc.
• Complications / breakage / discomfort — explicit, even if "none." A loose bracket, debonded attachment, or aligner tracking failure documented today is a defensible reason for the next visit's modification.
• Plan modifications — any change to the original case plan (extended timeline, added elastics, switched to refinement scan, change in extraction plan, etc.) and the clinical rationale.
• Next visit interval and goals — typically 4-8 weeks for fixed appliances, 6-10 weeks for aligner check-ins. Document the planned procedure for the next visit.
• Operator initials — when assistants perform portions of the visit (wire ties, elastic placement, photo capture), the auxiliary operator's initials should appear with the doctor's.

The "amnesia test" applies: a third party reading the note must be able to reconstruct (1) where in the case plan this patient is, (2) what was actually done today, (3) whether the case is on track or drifting, and (4) why this interval was chosen. Auto-populated default-normal templating ("Treatment progressing as planned. OH WNL. NV 4 weeks.") on every visit is a known audit pattern.

Common denial reasons

The most common reasons D8670 is denied, downgraded, or recouped:

• Billed more frequently than once per quarter — by far the most common new-biller mistake. The office bills D8670 every month for the patient's monthly adjustment visit; the carrier pays one and denies the rest as duplicate within the 90-day window. The fix is to align claim submissions to the carrier's quarterly cadence, not to the office visit cadence.
• No case-start code on file — D8670 submitted on a patient who has no D8080 / D8090 / D8030 / D8040 / D8210 / D8220 in the carrier's claim history. The carrier sees no active case and denies D8670 as orphaned. Patients transferring from another office mid-treatment are the highest-risk population — a transfer narrative with the prior provider's case-start date, the original case plan, and the current treatment phase is required.
• Bundled into D8080 / D8090 — the plan does not separately reimburse D8670; the case fee is the full reimbursement. The claim is denied as "included in case fee" or processed at $0. This is not an error to fix; it's the contractual reality of that plan.
• Lifetime orthodontic maximum exhausted — the patient's lifetime ortho benefit (e.g., $1,500 or $2,500) has been paid out across earlier banded payments; further D8670 is patient responsibility regardless of clinical activity.
• Case past projected end date without an extension narrative — banded-schedule plans pay through the originally projected case length. Continuation visits past that date require a written narrative justifying extended treatment; without it, D8670 is denied as out-of-benefit.
• No prior authorization on file — many plans (especially Medicaid and Medicaid MCOs) require prior authorization for the entire ortho case (D8080 / D8090); D8670 quarterly continuations inherit that authorization. A case started without auth has D8670 denied along with the case fee.
• Insufficient progress documentation — Medicaid MCOs and some PPOs require a progress narrative for each quarterly D8670; "treatment progressing as planned" without specifics is interpreted as missing documentation. Site-specific tooth movement, current treatment phase, and projected completion date are the highest-yield items to include.
• Same-date conflict with D8696 / D8697 — repair of broken appliance (D8696) on the same date as a scheduled D8670 visit may bundle into D8670 on some plans; some plans pay both, others pay only D8696. Verify before billing both.
• Ortho not a covered benefit — adult orthodontic benefits are excluded on many plans; the entire case (case fee plus D8670 continuations) is denied. The fix is to verify ortho coverage at consultation, not after the case starts.
• Patient transferred mid-case without records — without records from the prior office, the carrier cannot validate the patient's case stage or progress; D8670 is denied pending documentation.
• Pediatric medical-necessity threshold not met — Medicaid pediatric ortho coverage typically requires the patient to meet a state-specific HLD (Handicapping Labio-lingual Deviation) index threshold; cases that don't meet the threshold are denied as cosmetic regardless of clinical merit.

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