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    What 2018 means for insurance coding

    What you need to know, what you can ignore and how to keep from getting into trouble.



    For some patients, getting to the doctor’s office can be difficult — if not impossible — and one effort to reach those patients is through teledentistry. Hygienists could be in an affiliated practice or they may own their own practice, in states where that’s permitted. It could also apply to dental therapists.

    “There are already some services that provide teledentistry reimbursements. Some states do,” Duncan says. “California has been providing this in certain state programs, but the fact is that we don’t have enough providers in certain areas. Teledentistry is a good way to offset that by having the ability to check in with a doctor that is not necessarily on-site. We can still help patients that can’t get to a doctor’s office. Maybe they’re not mobile or they live very far away. Maybe they just cannot afford to take time off of work. There are many different uses for teledentistry in these situations. I feel like we are following the trend set by medical plans. Medicine has had these types of codes for a long time.”

    “It’s been key to getting hygienists out to rural areas and to be able to perform services,” Sanders observes. “But, legally, they still need a dentist’s eyeballs on the patient’s case. So, they do teledentistry, which allows them to take X-rays and intraoral photographs and send these images to a dentist. They’ve got a contract with that dentist who will open up those files, they’ll take a look and if they see anything suspicious, they will be available for a consult. The problem has been that there’s no code to allow for payment of the doctor who is reviewing the radiographs or the intraoral photos.”

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    In the past, hygienists may have just paid a stipend to a dentist for their services.

    “Now, there will be a recognized code by the CDT, and the hope is that now insurance companies will be able to reimburse that stipend so that doctors are getting paid, kind of like an exam,” Sanders says.

    Two new codes cover teledentistry: D9995 for synchronous communication and D9996 for asynchronous communication. The difference between synchronous and asynchronous is whether the communication is performed in real-time or the information is saved and forwarded to the dentist for later review.

    “Synchronous means a direct connection like FaceTime,” DiGangi explains. “Asynchronous is like an email because you write it at one time and it is read and interpreted later.”

    Those teledentistry communications extend beyond a patient visit and can include other members of the dental team, too.

    “A lot of times people think of teledentistry as being able to access more care in public health, and, yes, it is, but in addition, it’s a way for us to better connect between dental professionals,” DiGangi says. “We’ve long been saying, ‘Here’s your little referral card,’ and we send people over to a periodontist and the periodontist sends a little card back. Well, we can actually do better patient sharing and better patient connections with the use of teledentistry.”
    Evidence of teledentistry’s effectiveness was key for the creation of the new codes.

    “The code committee looks at these things and votes on these things based on a whole bunch of different reasons,” DiGangi says. “What the people that submitted for the teledentistry code have done on this — what they can show — is that care in a teledentistry setting is equal to what you can do in a brick-and-mortar office. What teledentistry can do is be a way of expanding a practice without having to build another treatment room. Because you can send a hygienist or an assistant out to a senior center, they can do a screening on the 50 seniors that live there, and if they find there’s something going on or if the dentist sees and diagnoses, either synchronously or asynchronously, that 10 of these 50 need some kind of dental care, those 10 dental patients now go to that dental office.

    “So, yes, it is a bit of a forward-thinking thing. I wouldn’t say the codes committee are the forward-thinking people, but when they were presented with teledentistry codes a couple of years ago, they said no, and after they said no the first time, the ADA House of Delegates looked into this and they actually created policy on the use of teledentistry. So, when the codes came back to the committee, the ADA — in a proactive way of looking at the future of dentistry — decided that these codes were appropriate.”

    Teledentistry has the potential to create big changes in dentistry, especially if it is used in conjunction with other healthcare disciplines.

    “Teledentistry is something that is relatively new, but it’s going to take dentistry, I think, into an entirely different realm with the opportunities that we can have to collaborate with other practitioners, collaborate with other medical providers,” DiGangi says. “For instance, let’s take the HBa1c plus teledentistry and now we really have a different kind of connection and way of thinking about what we can do as dental professionals.”

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    Robert Elsenpeter
    Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author ...


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