Billing for teledentistry is the most common concern following the COVID-19 pandemic. Teledentistry as a care modality is gaining popularity and is being compensated by payers.
Teledentistry is the use of telehealth systems and methodologies to deliver patient care in remote locations.
Teledentistry has two modalities of services. Synchronous and asynchronous CDT codes were introduced by the ADA in 2018 for billing and reporting services. The ADA Health Policy Institute shares insights that around 14-18 percent of dental practices in the U.S. use remote care for review appointments, making oral care accessible to many individuals.
The D9995 dental code is live interaction via remote meetings. The interaction is between the dentist and the patient. Synchronous teledentistry is a two-way communication protected by technology. It allows the patient to receive immediate attention during the unavailability.
The patient calls the office about a damaged tooth. The evaluation requires a live consultation and urgent examination. The doctor determines if it is a crown extraction scenario or a small chip repair. The standard protocol is D0140 Limited Oral Evaluation with CDT D9995 for a synchronous teledentistry encounter.
The D9995 dental code is used for post-operative evaluations, patients with transportation barriers, and mobility challenges.
The documents include tools to record the start and end times of the real-time encounter. Document the technology of the HIPAA-compliant video platform. Clinical findings and the reason for the teledentistry option. For billing the D9995 CDT code for the primary dental service, such as urgent triage, evaluation, and consultation. Finally, the authorization from the patient is for teledentistry services.
Thorough claim preparation is a must for successfully billing D9995. The practical advice is as follows:
Teledentistry requirements are quickly changing post-pandemic. To keep up with changes in payer requirements is key.
For instance, a patient had a surgical extraction and contacted the office due to some discomfort. To put this into perspective, the dental office schedules a video call for immediate care. As it is a synchronous encounter, the dentist, through this real-time connection, examines the site.
The following procedure codes are reported: D0170 post-operative evaluation and D9995 for synchronous teledentistry. For documentation, the time of the call, clinical notes, authorization, and the technology used ensure proper care. Patient satisfaction is improved, citing convenience and time savings.
Billing for teledentistry can not be dormant, as the projected future of teledentistry is expected to reach $4.8 billion (USD) by 2030, according to the Global Teledentistry Market Report.
Asynchronous teledentistry, such as D9996, is applicable where patient data is shared and stored for review. There is no live interaction, and the X-rays and clinical photos are used for evaluation without contact.
D9996 includes explicit record-keeping and documentation. The information gathered clearly justifies the medical history, images, and oral photographs. The date and the technology used to send and collect information. Finally, the professional treatment advice and conclusions for the evaluation.
Here are the billing and insurance considerations to help you through the process.
Insurers are particular about teledentistry services. It is better to revisit the plan's benefits before offering any services to patients. D9995 and D9996 have independent goals and cannot be used interchangeably.
Asynchronous consultation is dependent upon the treatment notes, photographs, and written explanations that cannot be left behind in order to control reimbursement. Once the claim is submitted, look for the claim responses on EOB statements and address the denied and underpaid claims as quickly as possible.
And if there is a denied claim, submit the appeal with the necessary records to justify the medical necessity of the remote evaluation.
Dental practices can benefit from D9996 and can extend patient access. For instance, a young patient suffers from a dental issue during school hours. The school health aid gathers all the necessary information, with mouth pictures, and sends it to the dental practice. The dentist examines everything and provides care instructions.
D9996 works with the primary procedure codes. An adjunctive code that is not a standalone service and requires compliance with the primary treatment.
No, it is an encounter between a single provider and a single patient. The group teledentistry session does not comply with the D9995 code criteria and should be documented accordingly for the clinical record.
These codes are filed against a dental benefit plan. Medical benefit plan completion instructions differ and use a unique format with separate code sets.
Have to learn more about billing. Book a demo today with Capline Dental Services. The team of professionals can help dentists with their billing to maximize reimbursements.
