Teledentistry Codes and Billing for Remote Care

Teledentistry is becoming the default after COVID-19. Since the patient and the dentist providing services are at different locations, it is essential to understand the billing norms for insurance companies to cover teledentistry services. Teledentistry codes are crucial when requesting reimbursement, and having a solid understanding of coding minimizes denials and delays.

This article by Capline Dental Services conveys information that is becoming viable in the dental field. Teledentistry is a new revenue stream that does not restrict dental care for those who need it. The ADA (2023) develops technical reports that must conform to the fact that 23 percent of practices used teledentistry as their preferred mode of care. The number was significantly low and had been reported at up to 2 percent prior to the COVID-19 pandemic.

Why is the use of teledentistry codes beginning to change the delivery of dental care?

Patients need to receive oral care, but the involved person is not available in the same physical location. The authoritative associations define teledentistry as the use of electronic media, including audio, video, and data communication, to store and forward through technologies, enhance services, diagnosis, consultation, treatment, and offer dental education.

Teledentistry coding involves synchronous and asynchronous coding. Synchronous means real-time consultation through the video feature. Asynchronous involves submitting recorded information to the dentist for review and receiving a response accordingly.

A reliable billing company, Capline Dental Services, can help the dental practice with documentation and claim submissions.
There is now an option, synchronous or asynchronous teledentistry billing codes, along with other diagnostic codes.

D9995 Teledentistry code entry is for synchronous or real-time encounter, along with other procedures on the date of service. A statistical survey by the National Network for Oral Health Access 2022 found that 87 percent use this code for live video consultations, while 62 percent use D9996 services.

D9996 Teledentistry code entry is for asynchronous information, which is stored and forwarded to the dentist for follow-up, along with other procedures on the date of service.

How to benefit from teledentistry codes?

To accomplish more with remote dentistry, here are some useful points:

• In addressing the problems, patients have access to dentists and receive immediate care for pain and soreness issues. Doctors share the e-prescription to control symptoms until the patient is treated at the office.
• The rising cost of an in-office fee and the consequences are negligence of care. Cost efficiency in terms of saving on transportation and other small expenses. It is a good diversion to have better health.
• Many patients feel anxious in the office environment, and surely, remote care is a healthy option to stay active with dental care, with the comfort of their own home.
• It increases the accessibility of dental care to individuals with disabilities, those with insufficient commute, and facility residents.
  A larger population has access to specialists, thereby improving specialty care.
• The prospect of telehealth is ever-expanding in the future, with the integration of dentistry with the healthcare system to benefit children, working individuals, and people with limited mobility.

What are the attributes of billing and reimbursement for teledentistry codes?

Teledentistry treatments are a protected benefit by specific insurance carriers. As stated by the ADA, all public and private programs should provide the same benefits for remote care, similar to those of office visit services. The current dental plan's coverage and reimbursement are in accordance with that.

Teledentistry allows social media platforms, such as FaceTime, Messenger video chat, Skype, and Hangouts video chat. What is not covered is TikTok, Facebook Live, and Twitch. HIPAA compliance is strict with these telehealth communications, but to improve patient care, the selected social platforms are used for remote care. Although it is subject to state laws and regulations.

That being said, insurance processing is challenging and considered an administrative cost rather than a necessity. The ADA recommends documenting all associated costs for a virtual visit to facilitate connection and interaction with the patient. Before practicing teledentistry, check with the state regulations.

Here are the recommended FAQs to help you understand and document teledentistry billing codes.

How to report D9995 and D9996 on a claim for teledentistry codes?

Claim submission has individual details about the patient to identify particular procedures and the date of service. D9995 and D9996 are reported with other procedure codes, such as diagnostic imaging or prophylaxis. A separate service line for claim submission in teledentistry codes, along with other procedures in a virtual encounter.

Why does teledentistry have only two CDT codes?

The CDT coding system simplifies documentation and reporting, exchanging information under a synchronous or asynchronous framework. Ultimately, the two CDT codes integrate the nature of the encounter regardless of the modality.

What documents should be maintained for the patient record when submitting a claim for teledentistry codes?

The practitioners of teledentistry should include CDT codes for the type of teledentistry encounter and obtain additional state documentation. Claim submission should follow the guidelines for the ADA paper claim form and HIPAA standard electronic dental claim. Medicaid would want additional claim reporting requirements.
The billing and reimbursement statistics indicate that 55 percent of providers encounter challenges with teledentistry codes, resulting in denials, and 61 percent lack clarity about code usage and supporting documentation, as per HPI’s 2023 survey.

What are the top reasons for denials in teledentistry codes?

The impact of denials on providers and patients leaves them with a terrible experience. It can be prevented through identifying the reasons.

Here are the main causes:

• The details are incomplete, missing information that leads to varying CDT codes, and do not clearly explain the necessity for the performed procedure.
• Then, coverage limitations are associated with dental plans. The process of checking plan limitations is mandatory before the treatment begins, as it can lead to billing surprises.
• Lack of CDT codes details and a missing diagnostic image can be a source of frustration when the office bills for services and later gets denied.

Contact the team of Capline Dental Services today to learn more about the hassle-free billing process.