Oral diseases can significantly affect the overall health, well-being and quality of life of people. Good oral health can be achieved through adequate preventive care, regular self-care, early detection, treatment and effective management of problems. The prevalence of dental diseases is disproportionately high among people with low income, wherein the resources for diagnosis, treatment, billing coverage and prevention are limited. According to the American Dental Association, the aggregate number of dentists in the United States appears generally insufficient to meet the scaling demands of the population for dental care. But, due to the variation in distribution of dentists across the US, rural areas have less than 1 percent active dentists (2018 statistics). To tackle the inadequate distribution of providers in dental medicine, telemedicine has used teleconsultation services to address the shortage of specialty providers in this area of specialty. This has been very successful in bringing patient-centered services to communities in need, while also demanding a teamwork-approach from clinical providers and community staff to deliver effective care. In fact, more Americans now express interest in consulting healthcare professionals when and where it is convenient for them. In fact, Parks Associates reports that 60% of households with broadband access “are interested in remote care that would take place online or by telephone.” As electronic technology continues to change the way dental practices do business, improving the process of recording and tracking patient health remains a primary challenge. Managing the dental billing services and getting reimbursed can also be a complex task.

What Is Teledentistry – Evolving Language and Laws

Telemedicine in simple terms is defined as the “use of medical information exchanges from one site to another via electronic communications to improve a patient’s clinical health status”. Also known as Telemedicine in dentistry, Teledentistry is a rising trend and an expansion of the traditional dental practice. With teledentistry, patients can have a virtual dental home in addition to a physical one. In addition, teledentistry can increase access to care and practice revenue streams by providing profitable outreach to the community without adding more chairs.

Teledentistry was included in the American Dental Association’s (ADA’s) Code on Dental Procedures and Nomenclature (CDT Code) for the first time in 2018.

The American Telemedicine Association has been leading the charge to use the broader term, “telehealth”. This term was defined by the Health Resources and Services Administration (HRSA) as – “the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration”.

Here discussed are some frequently asked questions and answers about Teledentistry –

Q: What is Telehealth and Teledentistry?

A: Telehealth is not a specific service, it refers to a broad variety of technologies and tactics to deliver virtual medical and health services. Teledentistry, according to the American Dental Associations (ADA’s) Comprehensive Policy Statement on Teledentistry, refers to the use of telehealth systems and methodologies in dentistry. Teledentistry can include patient care and education delivery using, but not limited to, the following modalities –

  • Live video (synchronous) – Live, two-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology
  • Store-and-forward (asynchronous) – Transmission of recorded health information (such as radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communication system to a health practitioner. Practitioners may use the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction
  • Remote patient monitoring (RPM) – Personal health and medical data collection from an individual in one location via electronic communication technologies
  • Mobile health (mHealth) – Health care and public health practice and education supported by mobile communication devices

Q: What is the need for teledentistry services?

A: About 50% of people visit a dentist regularly. Outside of that percentage, others only visit when emergencies arise. The reasons for this include fear, cost, and the feeling that treatments will be never ending. As a result, most adults avoid going to the dentist as often as they should. Teledentistry services provides a more relaxed approach to addressing oral health needs, as well as being more cost efficient. Another need factor is the judgment of the dentist or other oral health practitioner all acting in accordance with applicable state laws or regulations.

Q: What are the key benefits that teledentistry offers to patients?

A: Teledentistry is a great tool for the dentist and patient to interact without the need for expensive, inconvenient in person visits. Some of the key advantages include –

  • Assessment – This technology can be used for making correct dental assessments. Patients can send photos, and videos for dentists to evaluate. Further assessment can also be made using existing dental records taken by a dentist in person and examined remotely.
  • Prescription – When a patient is in pain and is in need of an antibiotic for an abscess, a prescription can be provided remotely.
  • Supervision and monitoring – Teledentistry is a cost-effective way to monitor dental treatments, particularly in the case of orthodontics. It is a great way for a dentist to supervise and monitor the progress of teeth movement remotely, without having to call in the patient in every month.
  • Safe and effective option – Teledentistry treatments are now included in several insurance coverage policies, sealing it as a growing and permanent trend. In fact, studies shows that “virtual dental homes” are a safe and effective way to deliver oral care for the underserved, particularly in rural areas.

Q: Why are there two teledentistry CDT Codes, but four delivery modalities?

A: Delivery of Remote Patient Monitoring (RPM) and Mobile Health (mHealth) may occur in either a synchronous or asynchronous information exchange environment.

Q: What are the two Current Dental terminology (CDT) codes related to Teledentistry?

A: Teledentistry was included in the ADA’s Code on Dental Procedures and Nomenclature (CDT Code) for the first time in 2018. The two full CDT Code entries are –

  • 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).

Q: What are the notable attributes of a synchronous encounter reported with D9995, and asynchronous teledentistry reported with C9996?

  • Synchronous teledentistry (D9995) – refers to delivery of patient care and education where there is live, two-way interaction between a person or persons (e.g., patient; dental, medical or health caregiver) at one physical location, and an overseeing supervising or consulting dentist or dental provider at another location. The communication is real-time and continuous between all participants who are working together as a group. In addition, all involved persons are able to see what is happening in a natural manner.
  • Asynchronous teledentistry (D9996) – involves no real-time, live, continuous interaction with anyone who is not at the same physical location as the patient. Also known as store-and-forward, asynchronous teledentistry involves transmission of recorded health information (e.g. radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communications system to another practitioner for use at a later time.

Q: Who would document and report a D9995 or D9996 CDT Code?

A: The dentist who oversees the teledentistry event, and who via diagnosis and treatment planning completes the oral evaluation, documents and reports the appropriate teledentistry CDT codes. Applicable state regulations may also determine the oral health or general health practitioner who documents and reports these codes. Either one or the other teledentistry code is reported in addition to other procedures delivered to the patient on the date of service.

Q: Who would document and report other procedures delivered during a teledentistry event?

A: The dentist or other oral health or general health practitioner acting in accordance with applicable state law or regulation will report the related CDT codes for these procedures. Supervision requirements within a state practice act determine whether the dentist must document and report all the other procedures, or if they may be reported whole or in part by another type of licensed practitioner.

Q: When is more than one claim submission necessary?

A: More than one claim submission may be necessary when –

  • There is a continuum of care that begins with a teledentistry encounter at a remote location, and continues with other services being delivered at a dental practice location
  • State practice acts permit different licensed health care practitioners to submit claims for the particular services they provided during the teledentistry encounter

Q: Who has responsibility for services delivered via teledentistry?

A: Responsibility and liability for services delivered via teledentistry is determined by applicable state laws and regulations. However, each dentist, dental hygienist and others involved in a teledentistry appointment should become familiar with applicable state or federal regulations to determine their liability exposure and whether or not the person receiving care becomes their patient of record.

Q: How would D9995 or D9996 codes be reported on a dental claim submission?

A: A teledentistry event claim or encounter reporting the submission involves appropriate Place of Service (POS) code and CDT Code. These codes are reported in addition to other services (for example prophylaxis; diagnostic imaging) reported separately when the patient presents for care. They document services provided by the dentist, or other practitioner providing care, who is not in direct contact with the patient at the time of the encounter.

(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. CDT Codes D9995 and D9996 are effective January 1, 2018.).

Q: What type of coverage is offered for dental-benefit plans?

A: The American Dental Association’s (ADA’s) “Comprehensive Policy Statement on Teledentistry” offers a consistent and equitable coverage for all procedures associated with teledentistry services.

Dental benefit plans and all other third-party payers, in both public (e.g. Medicaid) and private programs, shall be provided 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. Coverage for services delivered via teledentistry modalities will be at the same levels as those provided for services provided through in-person encounters and not be limited or restricted based on the technology used or the location of either the patient or the provider as long as the health care provider is licensed in the state where the patient receives service.

With this huge shift towards teledentistry, video consults connect the patient’s laptop, tablet, or smart phone to a virtual dentist who diagnoses the patient’s problem and gets them start feeling better quickly. When follow-on care is needed, next-day appointments are booked with an appropriate dentist, conveniently located near the patient.

Failing to use accurate CDT codes in telemedicine documentation will cause payment delays and denials and also increase fraud risk. Fraud can lead to heavy fines, penalties, and even exclusions from certain healthcare programs. Dental practices can avoid questionable billing practices by opting for outsourced dental billing services. An established dental billing company will have AAPC-certified coders who remain informed about CDT code changes and payer guidelines, and can help providers submit error-free claims and ensure optimal reimbursement. Established medical billing companies also provide dental insurance verification and pre-authorization services, including patient registration and enrollment.