With offices closed for routine care, dentists are less accessible to their patients. However, dental needs will surely arise in the weeks ahead. Enter “teledentistry” – the trendiest buzzword of the month. Teledentistry offers opportunities for remotely reconnecting patients with their dentist. Virtual encounters can take on many forms, be it a message exchange, an email with photos attached, or a live two-way video consult.
- Capture high-quality images or video to detect presence of swelling, sinus tract, carious lesions, broken cusp or lesion on the lip or tongue;
- Coach your patient through self-assessment or basic testing;
- Discuss options, risks and costs in advance, then schedule a future visit appropriately with proper time and staff allotted;
- Offer home care advice or call in prescriptions* for analgesics or antibiotics, if warranted. *During COVID-19, DEA allows prescribing controlled substances to a new patient when first-visit encounter is a two-way, real-time audio-visual assessment. See DEA website for details and consult with state regulations.
Many telehealth regulations have been relaxed during this unprecedented time. Teledentistry is uncharted territory for Wisconsin dentists, seeing as our dental practice act is silent on the matter. No doubt, regulators are watching closely for fraud and abuse. I recommend using good judgment and playing it safe when in these gray areas, including the following:
- A virtual assessment is not a diagnosis. Even so, virtual check-ups allow us to preview the problem and provide interceptive care. Diagnoses need to be confirmed at next in-office opportunity.
- Keep a detailed log of all teledental encounters and write progress notes, just as you would for an in-person visit.
- Update and document health histories as part of your teledentistry encounters.
- Save and document images/video from virtual check-ups to patients’ charts, or better yet, save the message stream or record the video encounter.
- It seems like everyone is coming out of the woodwork to offer a virtual solution. Go with platforms and products with strong history and credibility in the teledentistry space.
- Although HIPAA is relaxed, it is still advised to avoid social media and utilize secure, private platforms for digital communications with patients.
A word on codes and claims
- Examinations performed remotely such as D0140, D0170, D0171, D0190, D0999 and others are being reimbursed by many third-party payers during the coronavirus outbreak. See ADA COVID-19 Coding and Billing Guidance for the most up-to-date list.
- Because teledentistry has not been adopted in Wisconsin, I feel the safer and cleaner play is to avoid using codes D9995 and D9996 altogether. These teledentistry codes are zero-fee codes. Omitting these codes should not affect the reimbursement for other services.
- Be up front and transparent with patients about billing for virtual encounters. Obtain patient verbal consent before charging or generating claims for virtual check-ups.
Efficiency for urgent needs
Urgent needs still warrant an in-person visit. Consider pre-screening cases via teledentistry (both for dental needs and patient health status) before making arrangements for in-person emergency care at the office. ”Front-end load” urgent appointments by doing a remote pre-appointment work-up, thus minimizing the time spent in your office. We must continue doing our part to divert dental needs from potentially overburdened urgent cares or emergency rooms.
Imaging is key
Anyone with a smartphone is already equipped with a high-quality camera. With good lighting and perhaps a small mirror, many areas of the mouth can be successfully imaged. You will only be as good as your imaging! I recommend using the main lens (not the “selfie lens”) for higher-resolution photos with a flash.
As for me, I have begun performing virtual visits, assessing patient needs, triaging patients for in-office care, and receiving reimbursement for exams via teledentistry. The demand is relatively low, but it’s working and it’s effective! How is your office innovating and responding to patients’ needs during office closures? Are you offering virtual visits to your patients?
For more details on teledentistry, please refer to ADA COVID-19 Coding and Billing Guidance.