Billing and Coding Guidelines for Teledentistry

Hey! This is Amber Darst, Dental Insurance Coordinator from Managed Outsource Solutions. I am going to be talking to you today about teledentistry.

This could be one of the most relevant topics we are discussing amid this COVID-19 outbreak. Now, as most dental offices are closed, dentists can use telehealth systems to continue to serve their patients. As dental care, too, is still necessary during this pandemic to maintain oral health.

So what is teledentistry?

A subset of telehealth, teledentistry facilitates dental care virtually. It works in such a way that, for instance – a patient takes a photo or video of their aching tooth and shares it with a dentist from a remote location, the dentist then examines the image or video and determines the problem with the tooth. After that if necessary, the doctor can prescribe an e-prescription for medicine to help with the discomfort until it heals or until the person can visit the physical office for a closer examination. A virtual consultation also allows a much safer approach to any questions a patient may have, giving them professional advice instead of them searching the internet and possibly finding vague or improper answers to their concerns.

Different forms of teledentistry include Synchronous Real-Time Video which is consultation using the video camera feature on a phone, laptop, or other device and Asynchronous Recorded Dental Health Information. This is documentation of dental health records like x-ray images or digital impressions that are sent via a secure electronic system.

A few benefits associated with remote dentistry are quick access for patients. Patients have the opportunity to immediately address pain and soreness issues with the Dentist and upon the discretion of the doctor, receive an e-prescription to help manage the symptoms until the issue can be treated in office. It’s also cost efficient. One way this can be a money saver as patients are eliminating the price for transportation to and from an office. Also it not having to spend extended hours away from their work for an appointment as well. Also it encourages those who may have anxiety with in-office dental visits to stay proactive in their oral healthcare from the comfort of their home.  It also increases accessibility of dental care to those who have limited transportation options, disabilities, or even nursing home bound patients. And the last benefit I would like to mention is it’s also great for specialists. It gives them a greater opportunity to consult with larger populations, improving specialty care.

So a little bit about the Insurance Coverage and the accessibility to the service. Currently in the US, teledentistry treatments are considered a covered benefit by select insurance carriers. Based on ADA’s statement on  teledentistry, these dental benefit plans shall provide coverage for services using teledentistry technologies and methods delivered to a covered person to the same extent that the services would be covered if they were provided through an in-office encounter.

Due to the COVID-19 pandemic HIPPA has currently eased up on some other normal regulations for providing teledentistry services. During this time it is possible to access the services via a few different social media platforms such as Skype or Google Hangouts video chat feature. Remember a teledentistry event is subject to applicable law, regulation or licensure.

The coding involved for teledentistry. So a teledentistry event claim or encounter submission involves reporting appropriate Place of Service Codes as well as CDT Codes. The Place of Service Code or POS code for a Telehealth encounter would be 02.

The two different CDT codes to choose from would be either the  D9995 which is for the Synchronous- real-time encounter or the D9996 for the Asynchronous – the information stored and forwarded to dentist for subsequent review.

The appropriate code should be entered by the dentist who oversees the teledentistry event and who ultimately completes the oral evaluation.

A DentaVox survey on teledentistry done on October 2019 found that 78% of patients are likely to start using remote dentistry within the next five years and the top 3 groups who benefit from this service are working people, children, and people with disabilities.

What better time to become part of this growing telehealth industry and even once this pandemic is over teledentistry will still be a great tool to implement, especially for those late night emergency calls.

I hope this helps, but always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thanks for listening in!