Coronavirus Billing Guidelines
What do we do?
Coronavirus has caused the dental industry, along with many other industries, to quickly adjust and find a way to make ends meet. As dental and doctor’s offices close down during the Stay-At-Home Order, dentists are scrambling to find ways to run a dental business from home and continue to help relieve their patient’s oral pain. As things rapidly change, we wanted to offer some insight into how we can continue our “normal” as much as possible. So, we created this “COVID-19 Billing Guide” for you to help you navigate your way through this difficult time.
What are the codes?
Here are the 2020 Billing Codes for services rendered during the Coronavirus Pandemic and beyond. These are the billing codes for services rendered using telecommunication technology according to the ADA:
If you are providing care using telecommunication technology to triage patients or offer an evaluation to determine if the situation is urgent or emergent, then the following CDT codes can be used to document and report the services in the patient’s record and to a third-party payer.
Oral Evaluations: D0140 limited oral evaluation – problem-focused
An evaluation limited to a specific oral health problem or complaint. This may require interpretation of information acquired through additional diagnostic procedures. Report additional diagnostic procedures separately. Definitive procedures may be required on the same date as the evaluation. Typically, patients receiving this type of evaluation present with a specific problem and/or dental emergencies, trauma, acute infections, etc.
D0170 re-evaluation – limited, problem-focused (established patient; not post-operative visit)
Assessing the status of a previously existing condition. For example:
- A traumatic injury where no treatment was rendered but the patient needs follow-up monitoring;
- Evaluation for undiagnosed continuing pain;
- Soft tissue lesion requiring follow-up evaluation.
D9992 dental case management – care coordination
Assisting in a patient’s decisions regarding the coordination of oral health care services across multiple providers, provider types, specialty areas of treatment, health care settings, health care organizations and payment systems. This is the additional time and resources expended to provide experience or expertise beyond that possessed by the patient.
Teledentistry: When you are providing services in a teledentistry environment one or the other of the following codes would be reported in addition to those cited above –
D9995 teledentistry – synchronous; real-time encounter Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.
D9996 teledentistry – 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.
Sample Coding Scenarios
[Note: In all cases below the relevant teledentistry code should be included. Real-time synchronous versus Store and forward asynchronous]
Patient contact with dentist who provides the consultation using audio means only
- DENTIST: D0190 (screening) or D0999
Patient contact with dentist who provides the problem-focused evaluation using audio and visual means
- DENTIST: D0140 or D0170 or D0171
Patient contact with triage call center who then forwards to dentist who provides the problem-focused evaluation using audio and visual means
- CALL CENTER: D0190 (screening) or D0999
- DENTIST: D0140 or D0170 or D0171
Patient contact with GP dentist (or specialist) who then forwards to specialist (or different specialist) who provides the problem-focused evaluation using audio and visual means
- GP Dentist: D0190 (screening) or D0999
- GENERAL PRACTITIONER OR SPECIALIST DENTIST: D0140 or D0170 or D0171
Telehealth refers to a broad variety of technologies and tactics to deliver virtual medical, health, and education services. Telehealth is not a specific service, but a collection of means to enhance care and education delivery. Teledentistry refers to the use of telehealth systems and methodologies in remote dentistry. Teledentistry can include patient care delivery using, but not limited to, the following modalities:
- Live video (synchronous): Live, two-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology.
- Store-and-forward (asynchronous): Transmission of recorded health information (for example, radiographs, photographs, video, digital impressions, and photomicrographs of patients) through a secure electronic communications system to a practitioner, who uses the information to evaluate a patient’s condition or render a service outside of real-time or live interaction.
- Remote patient monitoring (RPM): Personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a provider (sometimes via a data processing service) in a different location for use in care and related
support of care.
- Mobile health (mHealth): Health care and public health practice and education supported by mobile communication devices such as cell phones, tablet computers, and personal digital assistants (PDA).
For more information: D9995 and D9996 – ADA Guide to Understanding and Documenting Teledentistry Events
During this pandemic, our goal as dental care providers is to use telecommunication technology to triage patients and conduct problem-focused evaluations to limit office visits to only those patients who need urgent or emergency care. Thus, at this time, most dentists will potentially be leveraging telecommunication technology to provide a limited scope (i.e., problem-focused evaluations and reevaluations) interactions 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 (apps) that can be used through cell phones, tablet computers and personal digital assistants (PDA). Further, as noted below the federal government has indicated that they will waive penalties for HIPAA violations against health care providers that serve patients in good faith through certain non-public facing everyday applications, such as Zoom, FaceTime or Skype. Having both an audio as well as a visual (video or photographs) component 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 (the procedure performed) can be documented. In addition, given the current exigent conditions, D9995 or D9996 (indicating the method of transmission i.e., synchronous or asynchronous) may be included. Please remember the foundation for the ADA’s position on coding – “Code for what you do, and do what you coded for.” The dentist is responsible for, and retains the authority for, ensuring the safety and quality of services provided to patients using telecommunication technologies and methods. Services delivered should be consistent with in-person services in the professional judgment of the doctor, and the delivery of services utilizing these modalities must abide by laws addressing the privacy and security of a patient’s dental/medical information.
Telephones that have audio and visual capabilities are appropriate for virtual evaluations. During the COVID-19 public health emergency, Office for Civil Rights (OCR) will not impose penalties for HIPAA noncompliance against health care providers that serve patients in good faith through certain 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.
- DO NOT USE public-facing technologies (examples): Facebook Live, Twitch, and TikTok, etc.
- CAN USE (examples): Apple FaceTime, 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.
Many dental benefits administers have required their staff to work remotely to conform to national guidelines requiring communities to mitigate transmission of COVID-19. ADA has been informed that claims submitted electronically are more likely to be processed on time and offices with Electronic Fund Transfer (EFT) capability will likely receive payment on time. Any transactions that involve paper processing will take longer under these extenuating circumstances.
Yes. During these times, there could be patients looking for dental care and may find you through the 4Smile’s Dentist Search tool or the benefit plan’s provider directory. We recommend that you offer assistance to these patients. Please note that a benefit through their plan may be dependent on the payer’s policies.
The teledentistry procedure codes exist to document and report the additional costs associated with the delivery of services when a patient and their dentist are not in the same physical location. These codes are analogous to other well-established CDT codes – “D9410 house/extended care facility call” and “D9420 hospital or ambulatory surgical center call” – that enable the dentist to document and report additional costs borne by a dentist to deliver services that would otherwise be delivered in office.
A dentist should separately report the full fee for the actual services (e.g., D0140, D0170, D0171, D9992) delivered to the patient. Dentists must also determine and report their full fee for the teledentistry procedure (D9995 or D9996 as applicable to a specific encounter). Note that additional costs that you incur will depend on the type of tools/technology you have in place and the type of services you will provide. For example, under normal circumstances, a virtual dental home, which offers the patient an opportunity to receive comprehensive care may be established using advanced telehealth tools/technologies. However, under the current exigent conditions, procedures that can be performed virtually are potentially limited to those noted in this guidance document requiring less complex tools/technology.
Factors to consider when determining the full fee include the costs to enable remote communication technology for the transmission of health information required to effectively connect and interact with the patient. The teledentistry procedure fee does not include the fees for actual services delivered to the patient as noted above. A separate payment for the D9995 and D9996 procedures will depend on payer policies.
The ADA is looking into this issue as of this writing and we will provide an update at a later date.
Some Tips and Tricks for Performing Virtual Evaluations
The following tips may be helpful in conducting virtual evaluations:
- Request patient to have a flashlight handy- in case lighting or visual issues prevent the dentist from seeing inside patient’s mouth clearly.
- Request patient to have a family member assist in holding the phone or retracting the cheek as needed.
- Request patient to download necessary apps and familiarize themselves with the apps before the appointment time.
We understand that this may still be a little confusing for some patients. For a complete list of benefits, per the ADA, please check out the last page of their guideline here to check your benefits.
Summary
Hopefully, this gives you a better understanding of procedures and protocols for handling telecommunication during the coronavirus pandemic. While navigating the billing code protocol for COVID-19 can be a little confusing, our team here at 4Smile is here to help you in any way we can. For more information, please visit our website to get more information on how to run your dental business from home during the Coronavirus pandemic.
