Dentistry will never look the same again: teledentistry, or telemedicine in dentistry, will be included in the CDT Code in 2018. Patti DiGangi, RDH, BS, explains what we know so far about the new teledentistry codes and what implementing teledentistry might look like for your practice.
Teledentistry, also known as telemedicine in dentistry, will be included in the ADA’s Code on Dental Procedures and Nomenclature (CDT Code) for the first time in 2018. (1) Telemedicine is defined as "the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status." (2) The patient outcomes of teledentistry can be similar to those of visiting a brick-and-mortar dental office. In addition, teledentistry can increase access to care and practice revenue streams by providing profitable outreach to the community without adding more chairs.
Evolving language and laws
Teledentistry is a rising trend and an expansion of the traditional dental practice. With teledentistry, patients can have a virtual dental home in addition to a physical one.
The American Telemedicine Association has been leading the charge to use the broader term, "telehealth."(2) This term was defined by the Health Resources and Services Administration (HRSA) as "the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration." (3)
Many individual states cover telehealth services in Medicaid programs. (4) Currently, 48 states and the District of Columbia provide some form of Medicaid reimbursement for telehealth services with nearly half of those now requiring private insurance plans to cover telehealth services. (4,5)
California and Arizona began covering teledentistry in 2015. Other states, including West Virginia, Hawaii, Oregon, and Colorado, have also considered passing legislation to allow teledentistry. (4)
The Kentucky Board of Dentistry discussed teledentistry during a 2014 board meeting, and a motion was made to form a teledentistry committee composed of stakeholders from the Kentucky Dental Association, the University of Louisville School of Dentistry, the University of Kentucky College of Dentistry, the Kentucky Dental Hygienists Association, the Academy of General Dentistry, etc. (6)
These are a few examples of the directions in which different states are moving. Passage of these two CDT codes for 2018 indicates dentistry has finally reached the tipping point.
CDT 2018teledentistry codes
This was not first time teledentistry codes were submitted to the Code Maintenance Committee (CMC), the group responsible for deciding codes. In March of 2015, the CMC rejected the submissions, saying teledentistry is not a procedure but rather a place of service. (7)
Late in 2015, it was determined that this definition was not accurate. This led to the "Comprehensive Policy Statement on Teledentistry," adopted by the ADA House of Delegates. According to the policy statement, "the provision of services using teledentistry technologies" needs to be "properly documented." (8) This requirement created the need for unique CDT codes. (8)
Although yet to be determined, the teledentistry codes will probably be placed in the Adjunctive General Services D9000–D9999 section of CDT 2018. These codes will most often be used in conjunction with other codes. The final language for the new codes with descriptions will not be available until later in 2017 for use with CDT 2018.
While the language is not yet final, the codes that have been accepted are as follows:
• Teledentistry: synchronous; real-time encounter
• Teledentistry: asynchronous; information stored and forwarded to dentist for subsequent review (1)
Promise of teledentistry for private practice
Using technology, dental professionals can screen, record, triage, diagnose, and order care to be performed remotely. Teledentistry holds promise everywhere but has been out of reach for many practices and public health programs because it has been complex, insecure, and costly. This is no longer the case.
For example, TeleDent by MouthWatch provides an easy, cost-effective, and secure way to facilitate teledentistry. To date, it is the only system designed specifically for teledentistry. (9)
A case study
A hygienist from a local practice is scheduled to provide hygiene services in a local senior living facility. The practice uses the MouthWatch TeleDent system with a laptop and intraoral camera. The HIPAA-compliant system uses encryption and a secure cloud server to connect providers and patient records.
During her visit to the senior living facility, the hygienist performs 50 reimbursable screenings and records patient information, individual exam details, and high-quality intraoral images using the MouthWatch TeleDent application.
There are two options for these screenings:
• The session can be live using a MouthWatch TeleDent video consultation with the dentist (synchronous, real-time).
• The session images, video, and other details can be recorded through the MouthWatch TeleDent cloud software to be reviewed at a later time by the assigned provider (asynchronous).
The outcome of this single off-site screening session is that 5–10 senior living facility residents schedule restorative care at the affiliated brick-and-mortar dental practice. The practice increases its revenue streams by providing profitable outreach to the community without adding more chairs.
Easy and affordable
MouthWatch's teledentistry solutions connect dental patients to imaging technology and clinical expertise at the point of care. The MouthWatch TeleDentsystem is designed to easily import x-rays and digital scans for clinicians performing off-site dental exams.
MouthWatch TeleDent also complements any practice management software. It exports images, clinical notes, and billing details. It also tracks current CDT billing codes. With the advent of new CDT 2018 codes, documentation will become even easier.
Despite being the only platform designed specifically for teledentistry, MouthWatch TeleDent is easy to implement and surprisingly affordable. The TeleDent subscription is available at an annual price of $299 per provider for unlimited use. Add the intraoral camera for another $299 each, and you’re ready to go.
The tipping point
Often the answers to difficult questions are both complex and simple. The term "the tipping point" is said to have originated in the field of epidemiology. Today, it's used in many fields to refer to the critical point in an evolving situation that leads to new and irreversible development.
For teledentistry, the tipping point has been reached—it is here to stay.
1. Burger D. Code Maintenance Committee OKs teledentistry, A1c codes. ADA News website. http://www.ada.org/en/publications/ada-news/2017-archive/march/code-maintenance-committee-oks-teledentistry-a1c-codes. Published March 14, 2017. Accessed March 20, 2017.
2. American Telemedicine Association. What is telemedicine? American Telemedicine Association website. http://dev.americantelemed.org/about-telemedicine/what-is-telemedicine#.WP5T-z-3WNY.
3. Health Resources and Services Administration. What is telehealth? US Department of Health & Human Services Federal Office of Rural Health Policy website. https://www.hrsa.gov/ruralhealth/telehealth. Updated November 2015. Accessed March 22, 2017.
4. American Dental Education Association. ADEA State Update: States file teledentistry bills. American Dental Education Association website. http://www.adea.org/Blog.aspx?id=23311&blogid=20132. Published March 10, 2014. Accessed March 22, 2017.
5. Center for Connected Health Policy. Telehealth Medicaid & State Policy. Center for Connected Health Policy website. http://www.cchpca.org/telehealth-medicaid-state-policy. Accessed March 27, 2017.
6. Kentucky Board of Dentistry Special Board Meeting [meeting minutes]. http://dentistry.ky.gov/Board%20Meeting%20Minutes/NOV222014minutes1.pdf. Published November 22, 2014. Accessed March 27, 2017.
7. Code Maintenance Committee. CDT Code Action Request 9/16/17 [internal document].
8. American Dental Association. House passes guidelines on teledentistry. ADA News website. http://www.ada.org/en/publications/ada-news/2015-archive/december/house-passes-guidelines-on-teledentistry. Published December 7, 2015. Accessed March 22, 2017.
9. Introducing TeleDent. MouthWatch website. https://www.mymouthwatch.com/teledentistry.php. Accessed March 27, 2017.