TELE-DENTISTRY...

Coverage for services rendered by teledentistry is predicated on policy and plan design.  For reporting purposes, during the current COVID-19 crisis, the most commonly-reported codes will be D0140 and D0170.  They should be reported simultaneously with the appropriate teledentisty codes.

There are two teledentistry codes, D9995 & D9996.

D9995 - tele-dentistry-synchronous, real-time encounter
Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.

D9996 tele-dentistry-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

What's the difference? In the world according to Joan...

D9995 - I like to describe this as "real-time" face time, text message video chats, etc.  Live vocal or visual interaction with the patient or dental auxiliary during information collection.

D9996 - You do not directly interact with the patient and the information is conveyed to you either by emails, text, etc. at a later time and possibly at a different location.

THESE CODES SHOULD BE REPORTED ONCE PER PATIENT to document the type of tele-dentistry interaction on the date of service.  UNDER NEW JERSEY LAW, TELEDENTISTRY SERVICES SHOULD NOT BE PERFORMED UNLESS THEY MEET THE SAME STANDARD OF CARE AS ARE APPLICABLE TO IN-PERSON SETTINGS.

Report what you do - do what you report.

THE PATIENT RECORD SHOULD INCLUDE THE CDT CODE THAT REFELCTS THE TYPE OF TELE-DENTISTRY ENCOUNTER, AND treatment records should be very specific to document the scenario in which the encounter occurs. 

A claim submission must include all the required information as your typical claim submission. Some government programs (e.g., Medicaid) may have some additional claim reporting and coding requirements.

Frequently Asked Questions

What is tele-dentistry?

There are a broad variety of technologies and strategies to deliver virtual medical/dental health and education services.  It is designed to enhance care. In dentistry, these methodologies can include patient care delivery using several techniques; the most common scenarios we will see in dentistry are as follows:

Live video (synchronous) A live two-way interaction between a patient, caregiver or provider and a dentist/dental professional using audiovisual telecommunications technology.

The code used to report this type of encounter would be D9995 - synchronous, real-time encounter

Store and forward (asynchronous) The transmission of recorded health information (radiographs, photographs, video, digital impressions, etc.) through a secure electronic communications system to a practitioner, who will then use the information to evaluate a patient's condition or render service outside of real-time or live interaction.

The code used to report this encounter would be D9996 asynchronous, information stored and forwarded to dentist for subsequent review.

Can I use my smart phone or a video conferencing service like Skype or Zoom? What about text message and emails?

Telephones that have audio and video capabilities are appropriate for virtual evaluations.

Will the insurance companies allow benefits for the two tele-dentistry CDT codes D9995 and D9996?

Some will and some will not.  At the moment, the ADA has received confirmation from Humana, United Concordia and Liberty that tele-dentistry codes will be benefited.  Delta, Aetna, MetLife, Guardian and Principal have advised the ADA that D0140, D0170 will be benefited if the codes are accompanied by the D9995 or D9996 code.  These codes are required as descriptor codes but will not be benefited separately as an additional benefit.

Can I provide a "problem-focused evaluation" on a new patient?

The answer is YES.  There could be patients looking for dental care and may find you through the ADA's Find-A-Dentist tool or the benefit plan's provider directory.  The ADA/NJDA recommends that you offer assistance to these patients. Keep in mind that the benefit through the patient’s plan may be dependent on the payer's policies.  If you need assistance with claims, please contact jmonaco@njda.org.

Do I need specialized equipment or a special app to perform problem-focused evaluation or re-evaluations virtually?

During this pandemic, our goal as dental care providers is to use telecommunication technology to triage patients and conduct problem-focused evaluations limiting office visits to only those patients who need urgent or emergency care.  Therefore, most dentists will potentially be leveraging telecommunications technology to provide a limited scope (i.e., problem-focused evaluations and re-evaluations) interaction with patients. This can facilitate providing advice and performing triage.  It can also facilitate planning for in-person interactions should they become necessary.

There are commercially available applications or apps that can be used through cell phones, tablet computers and personal digital assistants (PDA).  In addition, the Federal Government has indicated that it will waive penalties for HIPAA violations against healthcare providers that serve patients in good faith through certain non-public facing everyday applications such as ZOOM, Face Time or Skype.  Having both, audio as well as visual (video and photographs), components appears necessary to appropriately conduct a problem-focused dental evaluation. Note that some third-party payers in both private and public (Medicaid) programs may have additional guidelines to determine payment.

Once an evaluation is completed as described by the nomenclature and descriptor of the appropriate CDT Code, then D0140 or D0170 or D0171 (whatever the appropriate procedure performed) can be documented.  In addition, under these COVID-19 circumstances, D9995 or D9996 (which indicates the method of transmission) may/should be included. (*ADA.org)

Should I be worried about HIPAA compliance with video and virtual evaluations? *

During the COVID-19 public health emergency, the Office of Civil rights (OCR) will not impose penalties for HIPAA noncompliance against healthcare providers that serve patients in good faith through everyday communications technologies.  Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.

For example:
DO NOT USE public-facing technologies like Facebook Live, Twitter, and Tik Tok, etc.

CAN USE Apple Face Time, Skype, Facebook Messenger video chat, Google Hangouts video, Zoom.

Regarding emails and text messages, the OCR Notification does not address email and text communication.  HIPAA does not prohibit using email or text communications, but a dental office that wishes to communicate with patients this way must conduct a written risk analysis and implement reasonable and appropriate safeguards.  For some examples of safeguards contact dentalbenefits@ada.org (*Success.ADA.ORG)

I am hearing that some insurance companies have stopped processing claims.  Is this true?

Due to the COVID outbreak, many dental benefit administrators have required some or all staff to work remotely to conform to national guidelines requiring communities to mitigate transmission of COVID-19.  ADA has been advised that claims submitted electronically are more likely to get processed on time, and offices with Electronic Fund Transfer (EFT) capability will likely receive payments on time. Any transactions that involve paper claims processing will likely take longer under these circumstances.