State and local mandates against congregating in groups have made it difficult for many dentist offices to continue practicing in a traditional sense, and many more are taking extra precautions by instructing non-essential staff to stay at home. In light of the new status quo, some dental professionals are turning to teledentistry practices in order to bridge the gap in care. Read on to discover more about what teledentistry encompasses, as well as how you can handle certain issues related to billing and coding your services when teledentistry is involved.
What is teledentistry?
As a result of guidelines issued by public health authorities, dental practices are increasingly choosing to offer some teledentistry services in order to provide patients with quality dental care while maximizing the safety of patients and employees alike. Teledentistry doesn’t correspond to one specific service, but rather it refers to a suite of services offered by a medical care provider through the use of virtual technology. Teledentistry services can be employed with several distinct goals in mind or a combination of multiple desired outcomes, including patient education, monitoring of existing conditions, or diagnosis.
In terms of the ways that your office can practice teledentistry effectively, you have several methods at your disposal based on preference and the needs required by the type of care. Some of these methods include, but are not limited to:
- Two-way live video (aka synchronous communication)
Treatment delivered from a healthcare provider to a patient (or patient’s representative) via a live A/V connection where both parties are interacting simultaneously
- Asynchronous communication
Health information (such as video, photographs, x-rays, digital impressions, etc.) is transmitted to the healthcare provider who can then evaluate the situation and make an appropriate recommendation for treatment without live video interaction
- Remote patient monitoring
Health data is collected from a patient via a monitoring device and then sent either directly to the healthcare provider or routed through a third-party processing service where it can then be used for ongoing care
- Mobile health practices
Additional care and support provided through the use of mobile devices such as smartphones and tablets
Technological tools and HIPAA concerns
There are many varied types of technology that enable the practice of teledentistry on a wide scale. Some of them have been in use for many years and you may be intimately familiar with, whereas others are relatively new in the healthcare industry and are only recently seeing wide-scale deployment.
A variety of video conferencing services are available that can be accessed through a desktop or laptop computer, smartphone, tablet, or other mobile device. As a dental care provider, you may have questions about whether or not you can maintain HIPAA compliance regarding patient privacy while using audio and video transmission technology. Because of the COVID-19 pandemic, the Office for Civil Rights as a part of the U.S. Department of Health and Human Services has indicated that HIPAA noncompliance penalties will not be levied against healthcare providers using common communications technology services to provide telehealth services, as long as they are acting in good faith to preserve patient privacy.
So what does acting in good faith mean for your dental practice? In general, you should avoid consulting with any patient using a video service that features a public viewing option, such as most social media platforms including Facebook Live, Instagram, Twitch, and TikTok. Services that are strictly for communication between the parties involved can be used at your discretion, including Facebook Messenger, Google Hangouts, Skype, and Apple FaceTime.
Additionally, all care providers should enable any encryption measures available through these services, and they should take the time to inform patients of the inherent risks involved in transmitting sensitive information over third-party apps. It’s also important to address that HIPAA regulations do not explicitly prevent providers from communicating via text message or email, but individual offices should assess the risks of such communication accordingly and proceed in the best interests of the patient.
Teledentistry guidance for coding and billing processes
The ADA has released some new recommendations relating to coding of services and billing for teledentistry care. Some dental practices continue to remain open and see patients in the office during the pandemic, whether on a limited or normal basis. In these cases, any services provided to the patient should continue to be coded and billed as you normally would.
In cases of services provided using teledentistry methods, the ADA recommends that you utilize the following coding guidelines for record-keeping and third-party billing:
- Limited oral evaluation—problem focused: D0140
This code is used for patients who receive an examination related to a distinctive oral health issue
- Limited reevaluation—problem focused: D0170
Use this code when the purpose of the teledentistry appointment is to reevaluate a previously existing condition, such as a previous trauma or injury that needs monitoring but was not given specific treatment (this does not include reevaluations for post-op office visits)
- Reevaluation—post-op office visit: D0171
As indicated above, this is the code that should be used when the appointment is a designated post-operative reevaluation
- Dental case management—care coordination: D9992
Any time that is spent consulting with the patient about coordinating their oral care in situations that cross multiple areas of specialty treatment, providers, health care systems, etc.
Additionally, the new guidelines call for one of these additional codes to be added to the ones listed above in cases where services are administered via teledentistry:
- Teledentistry—synchronous: D9995
Add this code to one or more of the existing codes above in instances where treatment is provided through a real-time synchronous encounter such as video chat
- Teledentistry—asynchronous: D9996
This is used for all asynchronous teledentistry interactions, including those where health information about the patient is acquired from the patient and then sent to the dental practice for evaluation and review
In an effort to provide a repository of billing information to dental care providers, the ADA has been speaking with representatives from the major insurance providers to determine whether or they will process claims for services rendered through teledentistry. They have received confirmation from many of the providers that common codes such as D0140, D0170, and D0171 administered through teledentistry will be processed as regular claims, however not every third-party payer has responded to the inquiry. Check the ADA website for the most up-to-date details surrounding third-party payers processing teledentistry claims. You should also note that it’s important to clearly document any teledentistry services provided in the patient’s file for future reference.
Taking on new patients through teledentistry
One of the most common questions dental practices have during these uncertain times is whether or not teledentistry can be used to consult with new patients. Patients without a current provider may be looking for services during the pandemic, and they may contact you through the provider directory located on their benefits website. According to the guidelines from the ADA, it is recommended that you provide a problem-focused evaluation for new patients if you are able.
Submitting insurance claims for processing
Another important consideration for dental practices during the health crisis is whether or not insurance companies will be able to process claims submitted for teledentistry work. The logistics of the COVID-19 pandemic are changing rapidly in many locations throughout the country, and they are affecting the resources and capabilities of insurance providers as well as healthcare organizations such as dental practices. Much like companies in other industries, many benefits providers have ordered their non-essential staff to work remotely in order to follow the guidelines set forth by public health officials at the federal, state, and local levels and reduce the risk of transmission.
Because these benefit administrators may be working without access to some key on-site resources, claims involving paper documents may take longer to process for the foreseeable future. The recommends that dental care providers submit claims electronically whenever possible, and utilize electronic funds transfer capabilities in order to receive timely payments from benefit administrators.
Ensuring continuity of care with COVID-19 teledentistry
The current situation relating to COVID-19 is still rapidly changing, and it has already created a new reality for dentists and other health professionals who are attempting to deliver the same level of quality care while safeguarding the health of the population at large. In response to these shifting circumstances, the ADA and insurance providers are working to keep healthcare providers updated on current best practices and suggestions for making sure that services can continue for patients as uninterrupted as possible. Use this guide as a resource, but please remember that updates may render some information obsolete at any time. Remember to frequently check with the ADA and whichever benefit providers your practice works with for the most current guidelines related to teledentistry billing and claims processes.
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