Pre COVID-19 vs. Post COVID-19
D9995 and D9996
- Evaluation Codes
Michelle Strange [Ad 00:00:00 – 00:00:39]
And Andrew Johnston:
A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode.
Teresa Duncan: Hi. This is Teresa Duncan with the Nobody Told Me That! podcast and also the author of the book Moving Your Patients to YES!: Easy Insurance Conversations.
I’m here to talk to you today about teledentistry and the coding that surrounds it. You know, with COVID now, we have had to figure out different ways to communicate with our patient and different ways to actually provide treatment to our patient, and this is why teledentistry has really grown in popularity. Before COVID, it was really just kind of settling on the outside, and people were picking it up, but not in the numbers that they are now. COVID sort of pushed it forward in its trajectory, and now everybody is considering adding it to their treatment mix, which I think is a really good idea. And, hopefully by the time we finish this call or finish this discussion, you’ll be able to see it as well. Feel free to share this with your doctor and also with anybody on your team who feels that it might be — who you think it might be helpful for.
Okay. So let’s just go ahead and dig into it. We have two particular codes that actually cite teledentistry, and it is D9995, which is your synchronous meaning real time, and D9996 — I know it really just flows off the tongue, right? — and that’s asynchronous. Now, asynchronous is not what most people have been doing over the COVID times, but it’s probably going to factor if you decide to make this a regular part of your office treatment.
So, with synchronous, what that means is that you’re seeing the patient and talking to the patient and viewing the information real time. With asynchronous, somebody is collecting the information, and then a dentist will review it later and provide his or her opinion or recommends. So, for a hygienist, 9996 — if you’re out there in the public health and doing screenings and helping to gather information for a doctor who’s not on location, 9996 would be the code that you’re probably going to see used in your claims. But, for right now, we’re going to focus on talking to the patient in real time, and then what goes on after that.
So — oh, and also, I wanted to let you know that the ADA has a really nice guide on teledentistry and its uses. There’s one under the COVID section, and it’s called, you know, basically, a guide to teledentistry. And then they have another guide that’s linked within that that is all about teledentistry events and can kind of help you see also why it would be applicable in your office, like different situations and, you know, actually scenarios you probably haven’t even thought about, but once you read it, you’re like, “Oh, this could be really useful.” So I do recommend visiting the ADA guides to see if they can be more helpful for your team. Definitely share them with everyone.
Okay. So let’s move on here. You also, as hygienists, are possibly going to be asked to do screenings, and that could be also an asynchronous, and that’s where we go with the public health aspect. So I just wanted to make sure that you knew about D0190 before we move on, and that is the screening. You think of it as sort of a triage. That’s really what it means, and it’s basically to determine whether or not the patient needs to be seen by a dentist for diagnosis. So you’re not diagnosing, but you’re screening and then sending it for diagnosis, which is pretty much what you’re doing a lot of the times, right? Well, this also applies to — with dentists who are doing a quick screening over the teledentistry app or however you’re doing it and realizes “Okay. This is out of my purview,” and they send it on to another provider.
So, if it’s really a small visit, I mean, screening actually would be a more appropriate code. However, I will say that when I take a look at the time involved, which is gathering the information, having the patients fill out forms, all the technology that’s involved in that, I almost feel like you really should be looking at D140, which is of course your limited evaluation.
Okay. So, that being said, let’s go ahead and dip back into what you’re going to be doing if you’re seeing the patient or talking to the patient real time. Let’s go over the different evaluation codes that you can use.
So remember how I gave you the teledentistry codes? We’re going to stick with synchronous like I said, and that would be 9995. Now, it is not a code that’s going to typically pay out a lot. It really is more of a descriptor meaning it’s identifying the method that the care was provided. And so, really, think of it as a “this is how we provided the information.” Now, still bill for it because there are definitely companies who are actually providing benefits for it, but by and large, there’s really not a lot of benefit for the actual 9995 code.
So where the benefit comes in is with the evaluation code that you are providing along with the claim. So a lot of talk on some of the forums is that you can only use 140, which is the limited evaluation, and that’s just not true. Now, teledentistry is perfect for other uses such as a follow-up from a 140, and that has its own code, and it’s not limited to teledentistry either.
D0170 is one of the most criminally underused codes out there, and 170 is when you are doing a follow-up from a limited evaluation, which is, you know, problem focused. So an example in the office would be if somebody came in and said that they were possibly punched in the mouth, right? Okay. So that’s a problem focused. You’re taking a look at the effected area. And then you want to see in a couple weeks or ten days or however long, you want them to come back in because you want check to see if the mobility has gone away, you know, that periodontal ligament has tightened up. That would be a 170, which is actually a little bit higher paying than a 140. So don’t do — a lot of offices just do kind of a look-see and don’t charge for that. You absolutely should be charging for that, especially now with all the PPE that is involved. It is no longer — we no longer have look-sees anymore in dentistry.
Okay. If you have done scaling and root planning, if you have done osseous surgery, if your office has done implants or any surgical event, then the follow-up for that is actually 171, and that’s in office or via teledentistry. So let’s think about this in the long run. If you have a patient that you’ve provided scaling and root planning and you really just need to have them come back in to see, you know, how’s it going, you’re not doing probing on this visit — although, if he came into the office, it probably would be probing — maybe you’re doing this on the phone and doing a checkup, you’re talking about the follow-up care and all of that, the dentist would be able to charge the 171 even if it’s a teledentistry visit. So that’s really kind of important as far as expanding your exam codes — your evaluation codes that you’re going to use.
So, again, 170 is the follow-up from a limited evaluation, and that of course is in office or teledentistry. And 171 is the follow-up after a surgical event, which typically for all of you out there — RDHs out there, that’s your scaling and root planning, your laser treatments, and all of that. Those are definite surgical events, and the evaluation fee should be a little bit higher for that.
Okay. So let’s take a look at the screening code. So the screening code is also something that you could use in addition to the 9995, which is — I’m sorry, 9996. Actually, both of them, either synchronous or asynchronous.
Now, what I have been seeing just by looking at different EOBs and talking to the insurance carriers that I am tight with, I have not seen a lot of payment for the screening code. Typically, you see that a lot in state plans, and you see that a lot in some of the Anthems. However, you don’t really see that across the board as being reimbursed. The evaluation codes are definitely what you want to go for unless you are off-site. That’s how I feel about it. I’m not comfortable using the 190 on-site only because you’re really — there’s a lot more involved in the — the reimbursement is much lower than what you would get for an actual evaluation code.
All right. So what happens if your doctor — and this is not necessarily COVID times — what if your doctor is talking to another — talking to a physician and trying to coordinate care for the patient? Well, so just basically, you have evaluated the patient, and you’ve deiced that we need to talk to the MD before any treatment is made. 9311 is the consultation with a medical healthcare professional. 9311 is something that can be done via teledentistry meaning you could just hop on some secure patient portal or — secure means the communication, and I’ll talk about that in a second — and that could include an app or some of the other applications that are out there, like a dedicated app I mean. So that would be 9311.
Now, there is a code that’s out there that is the dental case management and the care coordination. That’s what it’s called: dental case management – care coordination. That is 9992. Now, this code is not used very often. Although, I really think it should be. This is when we are coordinating care over a few different providers and/or payment systems and/or organization — not organizations, like homes.
So, for example, if you have an elderly patient that you are trying to coordinate with the nursing home and then also the physician and then also the — maybe the adult children who are handling it or the estate who are handling the billing of it, that is all included in dental case management care coordination. I think offices should be using this a lot more because one little tip for you since you’re clinical is that the more a code is utilized, the more the data shows that people are using it, and that’s what pushes the carriers to consider reimbursement for it.
Now, I don’t know of any plans right now that are covering dental case management or — and care coordination. If you do know, if one of your offices is doing this successfully, please let me know because that’s the kind of information I like to share with my readers and also my listeners. My Facebook page is Odyssey Management, all spelled out. I have a lot of resources there for insurance. If you’re curious, you’re certainly welcome to take a look on there. But one of the topics that I constantly update on is whether or not certain codes are being covered. So I would love to share that if you have any experience with it.
So let’s talk about the different modes of delivering this. And that — I’m not going to go comprehensive on this, but I just want to say there are dedicated apps for this. And, if that’s the case, that’s great because they have built in forms, the have the built-in documentation guides for it and the templates for it. That’s another thing. You’re going to need to make sure you update your templates and make sure your providers are actually documenting. It’s really easy to take a look at somebody’s mouth while they’re sitting in their car in a parking lot and they’re helping out, but then they forget to write up the notes when they are logging into the office or when they get to the office, and that’s a problem. So these apps are really good at guiding you through that, and it’s also secure so the patient could download their end of it, their application, and it would be a secure connection between the two.
Other than that, if you don’t have that, if you’re not offering that, you could certainly use programs like Skype or Zoom. Now, here’s the issue is that the people who run HIPPA, what they are doing right now is waving — during COVID times — waving how strict they are with that because they’re not necessarily the most secure. However, in times of COVID, they’re not really going to be aggressive with, you know, prosecuting those who have broken HIPPA.
Now, once we get out of COVID times — if that’s even something that’s going to happen — when we get out of COVID times — I’m joking with that — when we get out of COVID times, HIPPA rules are going to actually go back into effect. And so, if you’re usually providing it via Zoom or Skype, you may need to upgrade and go and use a different application because of the HIPPA concerns. I am not a HIPPA expert, but basically when you use all of these tools that are not provided through an app, you have to be able to show that you are compliant with HIPPA. But here’s the thing: your office should already be able to show that anyways.
So I do think with all of these codes, it’s the — the ability is there to receive reimbursement for it or at least charge the patient, and the patient can be responsible for it after the carrier decides whether or not to provide benefits.
So, with that being said, just because there is a code for it, don’t make it fit what you’re doing. Take a look at what you did, and then see if the code is applicable. Doing it the other way is not quite what the code is for. I want you to code for what you did. That’s what I want. I want you to take a look at what you did and then find the appropriate code, not find the code and then say, “Okay. Well, we kind of did this.” So take a look at what you did, and be very clear with it, then find the right code.
So, real quick, just want to tell you that in this time of COVID, the most common combination that I’ve seen has been 140, which is the limited evaluation, and 171, which is taking a look at people after the surgical event so that they don’t have to come back into the office. And then, with those two codes, typically, it is synchronous meaning in real time. And so that — those are the two most common scenarios and codes that you’re really going to see in — I guess more frequently.
Now, if you get into the off-site and the asynchronous, it’s a whole different ball of wax, and I recommend that you read up on it. There’s definitely the ADA guides on it. There’s a lot of teledentistry webinars out there as well. If you go over to — if you do a search “Paul Feuerstein,” Doctor Paul Feuerstein did a really good webinar on teledentistry and went over all of the different apps that you could use. He’s a technology wizard as long with a clinician, and so he really kind of went in depth with that.
All right. I have rambled on enough about teledentistry. I appreciate you hanging in there. And, you know, you may need to rewind this and take a listen to it, and that’s okay. But, if you have any questions, please let me know.
My website, again, is odyssemgmt.com. You can find me on Facebook, Odyssey Management. That’s the full name if you just do a search for me. My name is Teresa Duncan. If you do a search for me on there, it’s pretty easy to find me, especially if you slug in “Teresa Duncan insurance.” It seems to be that I’m the only Teresa Duncan out there talking about insurance, which is just fine.
And, if you are interested in more management and insurance issues, check out the podcast Nobody Told Me That!. I talk all about leadership, management, and then definitely a lot of insurance. I did a whole episode on teledentistry when COVID first started and we were first using this, so that’s also a nice primer for you. It’s a full hour of me trying to teach teledentistry to a colleague of mine, and so that may help you as well.
Until the next TIPisode, I appreciate you taking the time to listen to this, and thank you to A Tale of Two Hygienists for hosting.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at firstname.lastname@example.org, and keep listening for more awesome content from your unofficial dental hygiene podcast.