Dentistry and COVID19
- Updated:
- March 2020
- Author:
- 3
- Topic:
- Workers Compensation
By now you have certainly heard of the corona virus. Maybe you first heard of it when news reports came from China where, as of February 28th, the Center for Disease Control (CDC) estimated the death toll as more than 2,800. Perhaps this hit closer to home as, in early March, journalists focused on the tragic loss of lives in a Kirkland, Washington, assisted living center, where at least 13 deaths were attributed to the virus. In the following weeks, the illness, now known as COVID19, spread quickly and as of today, March 24, 2020, CDC reports indicate there have been over 33,000 patients treated for the virus. Statistics show cases have now been reported in all 50 states, the District of Columbia, Guam, Puerto Rico, and US Virgin Islands.
You no doubt remember the reminders to “wash your hands, don’t touch your face, and stay home if you feel sick”. I remember hearing this and thinking. “several thousand are dead in China and the disease is already here, it will take more than washing our hands to control the spread.” We are all very aware of the devasting effect COVID19 has had on our communities, our health and our economy.
What I would like to discuss today is a topic many dentists are facing as they decide how to manage their practice in an environment unlike anything we have experienced before. Many dentists have postponed all elective procedures. This, while a difficult decision to make, is the right choice to not only protect themselves and their staff, but to slow the spread of the virus. For some dentists, this has meant closing the doors to their practice for several weeks.
Emergency patients will, of course, still require and receive treatment. That patient will call and you, as the dentist, will have a lengthy discussion about symptoms and recommendations. You may ultimately choose to meet the patient at your office for treatment. Of course, any treatment provided will be charged and billed to either the patient or their insurance. What about the time you spent with the patient on the telephone? Did you know that this is considered teledentistry and may be eligible for reimbursement by dental payers?
Telehealth has been an evolving trend for several years now in the healthcare world. Telehealth is defined by the Federal Health Resources and Services Administration (HSRA) as, “The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health related education, public health, and health administration”. This is a fairly broad definition, leaving a lot of questions as to exactly how telecommunication is accomplished. In our article “Telehealth/ Teledentistry: The Future Is Here”, published in the March/April 2018 issue of Insurance Solutions Newsletter, we outline the four types of technology used for telehealth. This article is also available on our blog at https://practicebooster.com/blog-article.asp?id=45618.
Today, we will discuss only one of these modalities: mobile health (mHealth). This method is supported by devices such as smart phones and tablets. Typically, this modality is not utilized on a wide scale due to HIPPA concerns. However, our healthcare system is facing some uncharted territory in the management of the COVID19 pandemic. In consideration of this, several concessions are being made to assist all healthcare providers. Last week, Secretary Alex Azar of the Department of Health and Human Services (HHS) announced an expansion of telehealth services for Medicare beneficiaries. His statement reads, in part, “Providers will be allowed to use everyday technologies to talk to telehealth patients”. This facilitates easier access to telehealth services. In addition, the HHS Office for Civil Rights (OCR) has stated it will waive potential HIPAA penalties for good faith use of telehealth during the emergency.
The full statement is here: https://www.hhs.gov/about/news/2020/03/17/secretary-azar-announces-historic-expansion-of-telehealth-access-to-combat-covid-19.html.
Why is this important? Most dentists do not have the specialized equipment used in typical telemedicine practice. During this time of crisis, it is considered acceptable to provide telemedicine using something as simple as a telephone. There is still an expectation that the dentist will, as much as possible, provide an environment of privacy. HHS has given examples of technologies which are considered acceptable as well as those which are not.
Acceptable telehealth communication platforms are defined as those which are non-public facing. These include, but are not limited to:
- Smart phones, either voice or text
- Apple FaceTime
- Skype
The use of public-facing platforms is not acceptable for telehealth communications. Examples of platforms which are not acceptable include, but are not limited to:
- Facebook Live
- TikTok
HHS has published an excellent document with FAQs on telehealth during the COVID19 crisis. This is available here: https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf.
Many of the major dental payers have expanded benefits to include teledentistry for dentists who have closed their offices due to COVID19. Although requirements for filing are plan specific, one consistent instruction we have found is that evaluations conducted via teledentistry are to be reported with D0140 (limited oral evaluation, problem focused). This should be reported and charged as if the patient was seen in the office.
Note that there are two codes specifically describing teledentistry. These are:
- D9995 Teledentistry- synchronous; real-time encounter
- D9996 Teledentistry- asynchronous; information stored and forwarded to dentist for subsequent review
To date, all payers that we are aware of state that these codes, while not payable, may be reported to indicate the service was via teledentistry and not in the traditional office setting.
When claims for teledentistry are submitted, the place of service (POS) will be reported as 02 (telehealth). Note that most dental software defaults to the POS of 11 (office) so be sure to manually change the POS to reflect 02 POS.
Accurate clinical documentation is essential to establish the emergent necessity during this time. A few points to consider include, but are not limited to:
- Document the method of interaction. Many payers specify that only services provided live, either via video or photo and telephone, are eligible for reimbursement.
- As always, document the reason for encounter/diagnosis and condition of patient. This is important to establish the emergent need for telehealth.
- Some patients may transmit photos to assist in their diagnosis and treatment. These photos should be stored in a secure location and will become a permanent part of their clinical record.
Although some dental payers have had policies on teledentistry benefits for some time now, others are implementing interim policies. As a result, requirements for filing may vary greatly. For example, some payers have stated there is a 90-day time frame during which telehealth claims will eligible for reimbursement. There certainly may be other requirements we are not yet aware of.
The American Dental Association (ADA) has taken a lead in researching and contacting the major dental payers to determine how teledentistry will be adjudicated. This information is constantly changing and is best accessed directly through the ADA website: www.ada.org. For additional information on teledentistry and other information pertinent to dentists while we “social distance” in the next few weeks, visit the ADA website.
In addition, we are always here to support our Practice Booster members. Stay safe and healthy.
This article may be freely republished with proper credit given to American Dental Support, LLC. and PracticeBooster.com.
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