4/13/20

Teledentistry Fact Sheet from the Indiana Dental Association

Telehealth and telemedicine have come to the forefront of discussion as a result of the COVID-19 crisis. As a

reminder, “telehealth” describes general functions of the health care system conducted over technology (such

as reviewing patient charts and protected health information), while “telemedicine” refers to patient health

encounters that occur via technology instead of in person.

Currently Indiana Family and Social Services Administration has indicated that although Medicaid approves

telemedicine and telephone options for most health care, it is NOT reimbursing dental claims on these

teledentistry codes sets.

The IDA and the ADA are investigating teledentistry and the impacts and applications to dentistry and the

dental office. The ADA’s current policy states: “The ADA is on record as supporting teledentistry laws, rules, and guidelines that provide patient protections by requiring high levels of care through the use of specialized teledentistry technology.”

The current COVID-19 outbreak and dentistry’s efforts to minimize the transmission of the virus has the ADA

urging state, federal, and third party payers to consider these circumstances and provide guidance on using

telecommunication and telehealth technology to perform limited problem-focused evaluations, re-evaluations,

and care coordination to triage patients or to determine if the situation is urgent or emergent.

Telehealth, telemedicine and teledentistry have several aspects in Professional Practice abilities and

applications, reimbursement eligibility processes and regulatory framework. In Indiana, all of these are being

developed and emerging.

In Professional Practice applications, only two CDT codes apply to the teledentistry scenario and would be used

in conjunction with another code as a modifier:

D9995—Teledentistry Synchronous; real-time encounter. Reported in addition to other procedures

(e.g., diagnosis (Example: D0140- limited oral evaluation-problem focus). Delivered to the patient on

the date of service.

D9996—Teledentistry Asynchronous; information stored for the dentist to look at later; reported in

addition to other procedures (e.g., diagnosis).

4/13/20

The codes that would most likely apply:

D0140—Limited Oral Evaluation: 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 patient needs follow-up monitoring; evaluation for undiagnosed

continuing pain; soft tissue lesion requiring follow-up evaluation.

D0171—Re-evaluation: post-operative office visit Case Management.

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

Below are some key points about teledentistry and billing:

• Again, note that the Indiana Family and Social Services Administration has indicated that Medicaid is

NOT reimbursing dental claims on these teledentistry codes sets.

• Some dental insurance carriers have indicated their support for a benefit for such evaluations

conducted virtually. You will need to check with individual carriers.

• We note that the Office for Civil Rights (OCR) has issued guidance that OCR will not impose penalties

for HIPAA noncompliance against health care providers that serve patients in good faith through

certain everyday communications technologies during the current COVID-19 crisis.

• Future teledentistry technologies will need to be HIPAA compliant.

• The ADA has issued its guidance on Coding and Billing for Virtual Services.

IDA continues to monitor, research the practice applications; reimbursements; and public safety regulations to

implement and allow Indiana Dentists to utilize telehealth and telemedicine in the dental practice setting.