This could be the most relevant topic 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 necessary during this pandemic to maintain oral health, teledentistry is a great option to consider. During this worldwide crisis, if extreme measures like mass quarantines ultimately go into effect, this will be the only way patients can be seen by their dentists. With this remote dentistry option, dental care can be provided to those in need without exposing them to any unnecessary risks as well as extra expenses.

What Is Teledentistry?

The American Teledentistry Association defines teledentistry as “the use of electronic information, imaging and communication technologies, including interactive audio, video, data communications as well as store and forward technologies, to provide and support dental care delivery, diagnosis, consultation, treatment, transfer of dental information and education”.

With advancements in the dental industry, teledentistry has just recently gained the attention of the medical community. Teledentistry creates collaborations between dental hygienists, dentists, patients and caregivers.

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 examines the image or video and determines the problem with the tooth, then, if necessary, prescribes medication 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 searching the internet and possibly finding vague or improper answers to their concerns.

Another utilization of teledentistry works by using dental hygienists to see the patient in person and then relay feedback to the dentists over an internet connection.

Different forms of teledentistry include Synchronous real-time video (consultation using the video camera feature on phone, laptop, or other device), and Asynchronous recorded dental health information (documentation of dental health records like x-ray images or digital impressions sent via a secure electronic system). Remote monitoring (collecting personal dental health information in one location and transmitting it electronically to another provider for future treatment), and Mobile health (consultation via mobile devices such as smartphones, tablets, computers, and personal digital assistants) Both Remote monitoring and Mobile health options can be used in either Synchronous or Asynchronous situations.

The ADA recommends that the treatment of patients who receive services via teledentistry must be properly documented and should include providing the patient with a summary of services. Reliable medical billing companies can support dental offices with documentation and claims submission.

How Teledentistry Benefits Patients and Dental Offices

Remote dentistry provides diverse benefits such as –

  • 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.
  • Cost efficient, often times lower than the cost of an in-office fee. Also eliminates the price for transportation to and from an office
  • Encourages those who may have anxiety with in-office dental visits to stay proactive in their oral healthcare from the comfort of their home

Increases the accessibility of dental care to those who have limited transportation options, disabilities, or even nursing home bound

  • Specialists can consult with larger populations, improving specialty care
  • Promotes the integration of dentistry into the larger health-care system. The telehealth industry has been established for some time now but is bound to play an even bigger role in the future.

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.

Dental Insurance Coverage for Teledentistry

Currently in the US, teledentistry treatments are considered a covered benefit by select insurance carriers. Based on ADA’s statement on teledentistry, dental benefit plans and all other third-party payers, in both public (e.g. Medicaid) and private programs, shall provide coverage for services using teledentistry technologies and methods (synchronous or asynchronous) delivered to a covered person to the same extent that the services would be covered if they were provided through in-person encounters. Current dental benefit plan coverage and reimbursement provisions should apply to services delivered in-office and via teledentistry.

According to Dentistry Support, as of March 23, 2020, a list of current dental insurance companies that are covering Teledentistry procedures include Liberty, Metlife, UCCI, Aetna, Principle, Human, Guardian, Ameritas, Delta Dental, Envolve and Sunlife.

Teledentistry allows access to its services through programs such as Apple FaceTime, Skype, Facebook Messenger’s video chat feature, and Google Hangouts videochat feature. Examples of what’s prohibited via public-facing technologies include programs like Facebook Live, Twitch, and TikTok.

HIPPA compliance does not typically allow these forms of telehealth communication, but due to the COVID-19 pandemic, these select social platforms are currently available to further aid with remote patient care. A teledentistry event is subject to applicable state law, regulation or licensure.

CDT Coding for Teledentistry

A teledentistry event claim or encounter submission involves reporting the appropriate Place of Service (POS) code and CDT Code. Any Teledentistry code submitted must be reported in addition to another procedure (diagnostic code), as these are not standalone codes.

  • POS code 02 (Telehealth – the location where health services and health related services are provided or received, through telecommunication technology) was added to that code set effective January 1, 2017.

Services provided in a teledentistry environment can be reported using D9995 and D9996 codes along with other diagnostic codes.

  • D9995 teledentistry – synchronous; real-time encounter

    Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.

  • D9996 teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review
  • Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.

The appropriate code should be entered by the dentist who oversees the teledentistry event and who ultimately completes the oral evaluation. Applicable state regulations may also determine the oral health or general health practitioner who documents and reports these codes.

Any other procedures such as prophylaxis, topical fluoride application, or diagnostic images delivered during a teledentistry event would be documented and reported using appropriate CDT Codes by the dentist or other oral health or general health practitioner acting in accordance with applicable state law, regulation or licensure.

ADA recommends that a claim submission must include all required information as described in the completion instructions for the ADA paper claim form and the HIPAA standard electronic dental claim. However, coverage and reimbursement for D9995 and D9996 is likely to vary between commercial benefit plan offerings and by state for government programs (e.g. Medicaid). Dental billing services provided by professional companies must make sure they are also up to date with the changing teledentistry coding regulations.