Telemedicine is the use of information-based technologies and communications systems to deliver health care across geographic distances.1 The use of this concept is widespread in the medical community, and its application in the field of dentistry has grown exponentially in recent years.2
The emergence of the COVID-19 pandemic spurred dentists and medical professionals alike to get creative in the ways they see and treat patients. In dentistry specifically, we have seen use of teledentistry increase as a tool that lets us remain accessible to our patients while abiding by regulations and recommendations limiting face-to-face encounters. It is clear that dentistry requires patient-to-provider contact, so the implementation of virtual exams and consultation models is carving its presence into our “new normal.”
Regardless of your practice specialty, the reasons to implement teledentistry into your repertoire of services is multifold. Using web-based consultations and screenings can reduce overhead costs, maximize time for both providers and patients, and allow for a more streamlined workflow. Coordinating consultations with patients, providers, and specialists is also beneficial for treatment planning and expanding the options of treatment phasing in complex cases.
Patient perspectives with regard to teledentistry are favorable and promising, as indicated in a survey conducted by DentaVox.3 These were the findings from the study:
• Patients are motivated by the availability of teledentistry and easy appointments when there is no other access to dentists.
• Patients see teledentistry used primarily for health promotion and education, diagnosis of dental disease, and risk assessment and preventive procedures.
• Populations of individuals that could benefit the most (and are most interested) in teledentistry are working people, children, and those with disabilities.
Some considerations to guide you while implementing your own virtual appointment model include billing and payments, platform options, and required regulations.
Billing and payments
First of all, we need to be reasonably compensated for our time. How does this work with patients who are covered by insurance? There is no quick answer as each state and insurance carrier have different regulations and restrictive clauses. In-network situations will need to be thoroughly researched before billing as well.
Codes for teledentistry encounters first appeared in the 2018 CDT, and privacy guidelines were first published in 2017. These are the ways to code teledentistry:
• D9996 (if a synchronous video platform is used)
• D9995 (if a photo or models are reviewed with a telephone call—i.e., asynchronous)
• The above two codes are used conjunction with a limited-exam code, such as D0140.
Some payments can be confirmed from dental insurance companies, but caution is advised because many carriers have limited payment only with regard to COVID-19.
Exactly how has the submission of these codes unfolded in real-world dentistry? An unofficial social media survey of a group of 5,000-plus dental office administrators noted payment for the exam codes and denial for the telehealth codes. To offset this, many stated they collected an average of $35–$50 at the time of the virtual encounter—despite insurance benefits—which then had the possibility of being applied toward patient treatment. This deposit was and is considered a way to reserve time in the schedule and to ensure better patient compliance in keeping appointments. As with all financial dealings, being up front with patients is vital to the success of teledentistry appointments.
As with most industries, dentistry is ever-evolving, and regulations with insurance carriers will likely change in the coming days postpandemic.
Privacy and platform considerations
Privacy protocols have been rapidly changing and evolving throughout recent years. Currently, HIPAA regulations have been relaxed to allow medical professionals to use virtual medicine models in good faith in consideration of patient privacy. This important guideline from the US Department of Health and Human Services has been updated for the current pandemic and can be found at this link.4 Be mindful that these regulations will change soon, and it will be important to remain compliant.
On this website, there is also a listing of advised platforms with the highest privacy considerations to use when implementing virtual exams. Doxy.me is one recommendation with a built-in payment feature that patients can utilize at the time of service, thus further streamlining workflow. Zoom, an emerging go-to for meetings during the pandemic, has also created a health-conferencing platform. The cost for these secure platforms ranges between $100 and $300 per month on average, depending on your need and the options you select.
Case in point
In my practice, a recent experience with an emergency patient sent over from the local ER proved how the application of this technology is beneficial, especially in the midst of the COVID-19 lockdown. An 85-year-old febrile, slightly amnesiac woman had fallen and sustained facial trauma that necessitated the services of an oral surgeon. Due to her injuries, health status, and poor mobility, her capacity to be seen was limited. Through coordination with our local oral surgeon, the patient was able to have her initial consultation with him while she was recovering at her home. She was subsequently scheduled for a dental visit and treated.
It is clear that the implementation of teledentistry is not a replacement for but an adjunct to make our services and capacity as providers more efficient. The technology allows us to offer new conveniences to various groups of patients. Like it or not, this type of “dental medicine” is here to stay. Phasing it into your practice will produce countless benefits, especially with services that do not require direct patient–provider encounters.