May 2020 Volume LV Number 3

 
 
 
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Coding Corner

May 2020 Volume LV Number 3

Dental Benefits
The ADA has sent a letter to third-party payers urging adminis- trators of dental benefit plans to adapt reimbursement procedures important to dentists and patients, including coverage for temporary procedures, teledentistry, out-of-network benefits, and fee schedule adjustment to account for cost of increasing infection control proce- dures. Visit https://www.ada.org/en/publications/ada-news/2020-archive/ april/ada-urges-third-party-payers-to-adapt-coding-and-billing-procedures to view the letter.
 
To find out more about how specific payers are managing the current pandemic, review pages 10 – 17 of the ADA’s COVID-19 Coding & Billing Interim Guidance at https://success.ada.org/~/media/ CPS/Files/COVID/ADA_COVID_Coding_and_Billing_Guidance.pdf ?utm_ source=adaorg&utm_medium=covid-resources-lp&utm_content=cv-coding-and- billing-guidance&utm_campaign=covid-19.
 
Delta Dental Plans of America recently issued a press release on its main website that provides links to summarize what the various states are doing to help providers.
 
Benefits provider Delta Dental of Arkansas has pledged $6.5 mil- lion in emergency financial assistance to dental practices in Arkansas. The Delta Dental of Arkansas Advance Receipts Program will pro- vide financial support to dental practices that are limited to providing only emergency services during the COVID-19 outbreak.

TELEDENTISTRY AND CODING
As a result of the COVID-19 pandemic and extenuating circum- stances, the ADA surveyed 21 Dental Insurance Carriers on benefits for limited problem-focused evaluations using teledentistry codes, consultations with physicians, and impact of frequency limitations for evaluations per year. Of the 21 responses, 19 are benefitting limited problem-focused evaluations (D0140) when using telecommunication technology. Two of the carriers are still reviewing its policies. Each carrier appears to have different protocols on combining the tradi- tional D0140 code along with attaching D9995/D9996 to indicate it is teledentistry. As teledentistry is a relatively new treatment option, the AAPD encourages a discussion with the parent or caregiver re- garding possible patient financial responsibility/obligations related to the virtual visit. The safety of the patient, family and caregivers is of utmost importance, and teledentistry allows most emergencies to be addressed in a caring, safe, patient-centered manner. 
 
United Concordia addresses COVID-19 concerns and current policy on teledentistry. Health issues with a video or photograph assessment with their dentists are covered for United Concordia’s members. The recommendation is to use CDT D0140. For more information, visit https://www.unitedconcordia.com/dental-insurance/home/ coronavirus/.
 
The fact sheet from DentaQuest provides COVID-19 crisis sup- port to dental providers, particularly on access to care and covered benefits for DentaQuest members via teledentistry. You can keep up to date with DentaQuest’s latest responses to the COVID-19 outbreak at dentaquest.com.
 
This fact sheet from Cigna Dental offers temporary guidelines for teledentistry consultations, including standard policies and use of procedure codes.
 
Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency. To promote increased access to services during this time of otherwise restricted access to clinical practices, the HHS Office for Civil Rights will be extending leniency toward HIPAA noncompliance of telehealth regulatory requirements.
 
The ADA Code Maintenance Committee (CMC) recently ap- proved new codes for COVID-19 tests. These codes become effective Jan. 1, 2021.

D0XXX antigen testing for a public health related patho- gen including coronavirus
D0XXX antibody testing for a public health related pathogen including coronavirus
 
The current code until CDT 2021 is implemented is:
D0999 unspecified diagnostic procedure, by report
Used of a procedure that is not adequately described by a code. Describe the procedure.
 
Please contact AAPD Dental Benefits Director Mary Essling for more information at messling@aapd.org or (312) 337-2169.

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