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ADA Guide to Understanding and Documenting Teledentistry Events

Tuesday, Apr 7, 2020

D9995 and D9996 ADA Guide - Version 2 - March 27, 2020 - Page 1 of 10

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09995 and D9996 - ADA Guide to Understanding and Documenting Teledentistry Events

 

Developed by the ADA, this guide is published to educate dentists and others in the dental community on these procedures and their codes first published in CDT 2018 and effective January 1, 2018.

 

Introduction

 

Teledentistry provides the means for a patient to receive services when the patient is in one physical location and the dentist or other oral health or general health care practitioner overseeing the delivery of those services is in another location. This mode of patient care makes use of telecommunication technologies to convey health information and facilitate the delivery of dental services without the physical constraints of a brick and mortar dental office.

 

The two full CDT Code entries are:

 

09995 teledentistry - synchronous; real-time encounter

Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.

09996 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.

 

The following pages contain a number of Questions and Answers, and Scenarios, all intended to provide readers with insight and understanding of how care is delivered and reported when teledentistry is a facet of the process.

 

Questions and Answers

 

  1. What is telehealth and teledentistry?

 

Telehealth is not a specific service; it refers to a broad variety of technologies and tactics to deliver virtual medical, health, and education services. As an umbrella term, it is further defined when applied to specific health care disciplines, such as dentistry.

 

Teledentistry, according to the ADA's Comprehensive Policy Statement on Teledentistry, refers to the use of telehealth systems and methodologies in dentistry . Teledentistry can include patient care and education 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 a 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.

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  • 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).

 

  1. Why are there two teledentistry CDT Codes, but four delivery modalities?

 

Delivery of Remote Patient Monitoring (RPM) and Mobile Health (mHealth) may occur in either a synchronous or asynchronous information exchange environment.

 

  1. What prompts the need for teledentistry?

 

Teledentistry is a means to an end - a patient's oral health. The reason or reasons why a teledentistry event occurs depends on the circumstances, such as when all persons who must be involved are not able to be in the same physical location. Another determining facet is the judgment of the dentist or other oral health or general health practitioner, all acting in accordance with applicable state law, regulation or licensure.

 

  1. How is a teledentistry event affected when the health care practitioners are in different states?

 

A teledentistry event is subject to applicable state law, regulation or licensure. All involved persons (the dentist or other oral health or general health care practitioner) must determine if a teledentistry event can occur when all participants are not in the same state.

 

  1. What are the notable attributes of a synchronous encounter reported with D9995, and asynchronous teledentistry reported with D9996?

 

Synchronous teledentistry (D9995) is delivery of patient care and education where there is live, two-way interaction between a person or persons (e.g., patient; dental, medical or health caregiver) at one physical location, and an overseeing supervising or consulting dentist or dental provider at another location. The communication is real-time and continuous between all participants who are working together as a group.  Use of audiovisual telecommunications technology means that all involved persons are able to see what is happening and talk about it in a natural manner.

 

Asynchronous teledentistry (D9996) is different as there is no real-time, live, continuous interaction with anyone who is not at the same physical location as the patient. Also known as store-and-forward, asynchronous teledentistry involves transmission of recorded health information (e.g., radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communications system to another practitioner for use at a later time.

 

  1. Who would document and report a D9995 or D9996 CDT Code?

 

The dentist who oversees the teledentistry event, and who via diagnosis and treatment planning completes the oral evaluation, documents and reports the appropriate teledentistry CDT code. Applicable state regulations may also determine the oral health or general health practitioner who documents and reports these codes.

 

As noted in their descriptors, either one or the other teledentistry code is reported in addition to other procedures delivered to the patient on the date of service.  In addition, both the individuals collecting records in the off-site setting and the dentist reviewing the records should document those activities in the progress notes in the patient's chart.

 

  1. Are there CDT Codes for: a) documenting collection and transmission of information in a teledentistry event; and b) for receipt of the information?

 

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There are no such discrete codes.  As noted in the answer to question #6, the collection, transmission and receipt actions should be noted in the patient's record.  An unspecified procedure by report code may also be used as part of this documentation, with the required narrative report containing the pertinent information.

 

  1. Who would document and report other procedures delivered during a teledentistry event?

 

The dentist or other oral health or general health practitioner acting in accordance with applicable state law, regulation or licensure, reports the appropriate CDT Code for these procedures, such as prophylaxis, topical fluoride application, diagnostic images.  Supervision requirements within a state practice act determine whether the dentist must document and report all the other procedures, or if they may be reported whole or in part by another type of licensed practitioner.

 

More than one claim submission may be necessary when:

 

    • there is a continuum of care that begins with a teledentistry encounter at a remote location, and continues with other services being delivered at a dental practice location, or

 

    • state practice acts permit different licensed health care practitioners to submit claims for the particular services they provided during the teledentistry encounter .

 

Notes:

 

  1. Teledentistry is a mode of dental service delivery that, when applicable, is reported in addition to the other procedures provided to the patient.

 

  1. Procedure delivery is by a natural person (e.g., dentist); the billing entity may be a natural person or a legal person (i.e., the facility where the service is delivered).

 

  1. The ADA's "Comprehensive Policy Statement on Teledentistry" states that dentists and allied dental personnel who deliver services through teledentistry modalities must be licensed or credentialed in accordance with the laws of the state in which the patient receives service. The delivery of services via teledentistry must comply with the state's scope of practice laws, regulations or rules.

 

  1. Who has responsibility for services delivered via teledentistry?

 

Responsibility, and liability, for services delivered is determined by applicable state law and regulations.  Each dentist, hygienist and others involved in a teledentistry appointment should become familiar with applicable state or federal regulations to determine their liability exposure, and whether or not the person receiving care becomes their patient of record.  Please note that "patient of record" may be defined differently under applicable state regulations.  This could be a factor to consider in a teledentistry event where the patient and some members of the team of providers are in different states.

 

  1. With responsibility comes potential liability - what should I do to protect myself and my practice when I engage in teledentistry?

 

As noted in the answer to question #9 (immediately above) liability is determined by applicable state law and regulations.  This concern should be discussed with your personal legal counsel and insurance advisor to determine whether or not your existing liability insurance policies cover this risk. Additional personal, professional and practice insurance coverage may be needed to address any coverage gaps.

 

 

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America's leading advocate for oral health

 

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  1. How would 09995 or 09996 be reported on a dental claim submission?

 

A claim submission includes the services provided to one patient.  Each claim detail line identifies the particular procedure and the date it was delivered to the patient.  D9995 or D9996 are reported in addition to the codes for other procedures (e.g., prophylaxis; diagnostic imaging) reported separately when the patient presents for care.

 

Appendix 1 contains teledentistry claim completion instructions illustrated with the ADA Dental Claim Form (©2019) for simplicity. The applicable teledentistry code is reported on a separate service line of a claim submission that also reports all the other procedures delivered during a virtual evaluation.  These instructions are also the model for reporting teledentistry CDT Codes on the HIPAA standard electronic dental claim transaction (837Dv5010).

 

  1. Are D9995 and D9996 used when a claim for teledentistry is submitted to a medical benefit plan?

 

D9995 and D9996 are CDT Codes that are applicable to claims filed against a dental benefit plan. Dental claim content, format and completion instructions differ from claims filed against a medical benefit plan. Claims filed against a medical benefit plan use a unique format, are prepared with different code sets, and follow their own completion instructions.  Medical benefit claims are outside the scope of this guide.

 

  1. What documentation should I maintain in my patient records, and what will be needed on a claim submission when reporting D9995 and D9996?

 

The patient record must include the CDT Code that reflects the type of teledentistry encounter, and there may be additional state documentation requirements to satisfy. A claim submission must include all required information as described in the completion instructions for the ADA paper claim form and the HIPAA standard electronic dental claim. Some government programs (e.g., Medicaid) may have additional claim reporting requirements.

 

  1. What dental benefit plan coverage - commercial or governmental - is anticipated?

 

Current dental benefit plan coverage and reimbursement provisions should apply to services delivered in-office and via teledentistry.  However, there is no expectation that commercial and government dental benefit plans must create new coverage provisions pertaining to teledentistry. Further, coverage and reimbursement for D9995 and D9996 is likely to vary between commercial benefit plan offerings and by state for government programs (e.g. Medicaid).