Teledentistry – a positive hope during this coronavirus upheaval?

President John F. Kennedy has famously gone on record stating that “when written in Chinese, the word ‘crisis’ is composed of two characters. One represents danger and the other represents opportunity.”

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Dr. Kazim

Although his literal interpretation of this Chinese word for criss may be questionable, his ideal and underlying message reverberates with us today. COVID-19 has transformed from a respiratory ailment to one that can lead to anosmia, nausea, fever and potentially fatalities. Because of the very real health ramifications, COVID-19 has been able to shut down travel, upend societal norms and has caused an indelible mark on the profession of dentistry.

Currently, I am in Long Beach, California, where our Governor Gavin Newsom issued Executive Order N-33-20 on March 19 requiring most Californians to “stay home or at their place of residence except as necessary to maintain continuity of operations of the federal critical infrastructure sectors.”

This was going to hit me…hard! But that’s okay, worst case scenario – I have my dental license for Washington State and/or New York! I’ll take a vacation, perform some temporary locum work (as I have done in the past), everything will be fine. Or so I thought! As in the coming days, similar orders were released by government officials in each of the respective states. The ADA provided its own guidelines.

Still grappling with student debt, preparing for my wedding and knowing that most of the patients I have seen could be in trouble – I definitely am stuck between a rock and a hard place. Yes, calls to lenders and landlords could be made or contingency plans to limit needless spending – however, I feel that the best solution to still generate some income at this time while also being a viable option to our existing patients is teledentistry.

Telemedicine, telepsychiatry…why not teledentistry? Yes, I know there are limitations – we don’t have the ability to perform root canals or extractions over the phone/virtual consult — however — we can offer preliminary diagnosis over the phone as abscesses often can be proven by mere visual sight. Can you offer a diagnosis stating that you can offer a complete root canal when society — and it will — returns to normal? Most likely not! However, can you offer a limited triage-like exam and offer to write a script of antibiotics/analgesics? Most assuredly.

Least we forget — we are doctors! Doctors of Dental Surgery and Doctors of Medicine in Dentistry have a responsibility to our patients to make sure they don’t clog up the emergency room with dental issues while our medical brothers and sisters fight tirelessly to combat this new virus. We, as a profession, are obligated to help out our fellow man with their oral needs. Until bans get lifted and a sense of normalcy returns, we owe it to our patients to use technology and our degrees to their maximum potential.

As of 2017, the ADA approved two new dental codes – D9995 and D9996. These codes will alert the third-party payers that the examinations code was delivered using teledental technology. These two will fast become your friends! These codes represent the two varying but accepted modalities for teledentistry which are synchronous (D9995) and asynchronous (D9996). The synchronous method is a real time two-party interaction between a patient and a provider through accepted HIPAA compliant software. Granted, rules may be in flux due to the extraordinary circumstances and can vary from state to state – so please verify before starting offering teledentistry. The asynchronous method typically is used to transfer diagnostic information to a dentist remotely for diagnosis at a later point in time. These two codes should be submitted in conjunction with the regularly submitted code. Personally, I use the D9995 + D0140 mainly. Most insurances are starting to adopt allowing this coding system due to the panic outside.

Most payers won’t provide a benefit for the teledentistry codes, but it is important to use them for accurate record keeping. However, remember the service you may be providing is the problem focused evaluation. The ADA has been talking to a number of payers who have noted that they will pay for these virtual evaluations. Check out the Coding and Billing Guide that the ADA has on its website.

Like most aspects of dentistry – documentation, documentation documentation! The interaction must be well documented in the patient’s chart – like any limited exam – and it must be noted which modality was used in the chart. If you want to submit the code to dental insurances, the code should be put under the “Record of Services Provided” section rendered on the date of service. In addition to adding the CDT code, the code 02 (teledentistry) must be added to the “Place of Service” portion. This is to ensure that we as dentists can properly be reimbursed for the services rendered.

Five years ago, I worked with various members of the Washington State dental community to allow for increased access to care for the rural populations. To the best that technology would allow, I worked to make sure that patients in the state had the chance to be seen and taken care for. I did not fathom that what I was working for then would have such a monumental national impact now.

Throughout all the turmoil and chaos that the past few weeks have brought us, I am still actively assessing needs of existing patients as well as offering basic diagnoses to help allay oral health concerns. This not only offers a sympathetic ear to hear the concerns of patients but also allows me to help prioritize patients’ chief concerns when the doors reopen for business. To this end, teledentistry offers the ability to look at yourself in the mirror and say that even with society in disarray I can still offer to help my fellow man and possibly save a life by freeing up an emergency room bed.

Stay safe, eat well, enjoy the break from the dental “rat race” – but please don’t neglect your patients and duties as a doctor.

Any questions or concerns that you think I can help with – please don’t hesitate to reach out to me at amir.e.kazim@gmail.com.

Lastly, don’t forget about the adage “this too shall pass.”

Dr. Amir Kazim was born in Toronto, Ontario, Canada. He completed his DDS at Howard University in 2014 and an Advanced Education in General Dentistry Program in the subsequent year at Yakima Valley Farm Workers Clinic in Spokane. During his time in Washington State, Dr. Kazim took on roles in many varying capacities such as working in Federally Qualified Health Centers, private practice as well as insurance audits and adjunct professor of restorative dentistry. To this end, Dr. Kazim played an integral role in bringing the merits of teledentistry to Washington by being one of the founding members of their established task force. While keeping busy with dentalrelated issues, Dr. Kazim enjoys traveling and experiencing new cultures and foods. Having recently moved to California, Dr. Kazim is excited to continue his efforts into this exciting new aspect of dentistry. He is a member of the ADA, the California Dental Association and the Harbor Dental Society.

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