Medical Billing for Telemedicine for DSM

Coding for telemedicine billing can vary, but knowing the intricacies is crucial to positive results. Rose Nierman shares her insights on medical billing for dental sleep medicine.

by Rose Nierman, Founder & CEO, Nierman Practice Management

Telemedicine billingThere’s a new buzzword in town, and that word is Telemedicine. Telemedicine encounters for Dental Sleep Medicine (DSM) are increasing, and rightly so! Research reports that telehealth interventions produce positive outcomes that are at the same level as face-to-face encounters. The most consistent benefit is when telemedicine is used for communication, counseling, and monitoring of chronic conditions.

In addition to DSM, telemedicine is commonly utilized for dental emergencies. Remote consults significantly reduce emergency room (ER) visits for patients with dental issues and frees up resources for other ER patients. During the remote session, medications, counseling, and instructions can be provided along with any needed recommendations for follow up care.

How Do I Code Telemedicine to Medical?

Coding varies by insurance carriers, so check with insurance plans to determine the coding guidelines. Many commercial carriers accept the same evaluation and management (E&M) codes that you would use for a face-to-face encounter, such as CPT 99202 for a new patient level 2 E&M visit. The dental practice can indicate that the encounter was a telemedicine visit by appending a CPT modifier (modifier 95 or GT) and/or using a place of service code that specifies telemedicine (place of service code 02).

Other medical insurers utilize the new 2020 CPT telemedicine codes:

99422        Online digital evaluation and management service, for an established patient,

for up to 7 days cumulative time during the 7 days; 5–10 minutes

99422        11–20 minutes

99423        21 or more minutes

Telemedicine billingInsurers have loosened guidelines for telemedicine reimbursement as a result of the COVID-19 pandemic. For example, Medicare’s adjusted telemedicine guidelines in response to the pandemic lifted restrictions that were previously in place that limited coverage for telemedicine services to situations such as beneficiaries in rural areas and/or with ambulatory limitations. Commercial carriers are now strongly recommending that patients utilize telemedicine for many situations.

As always, documentation is crucial to support billing of consults, x-rays, and custom-made oral appliances for Obstructive Sleep Apnea. Nierman Practice Management’s (NPM) DentalWriter™ questionnaire and exam forms generate a SOAP narrative report and the questionnaire can be completed online by the patient. Another SOAP report can be easily created for the oral appliance visit. Note that some insurers are now requesting a SOAP report for both encounters.

Additionally, NPM can help guide practices on solutions and can recommend a telemedicine platform with sleep physicians who are experienced in working with dentists for oral appliance therapy.

Please feel free to contact NPM for documentation, coding, and telemedicine solutions. We’re always happy to help your practice with DSM and medical billing implementation!

Rose Nieman helps you streamline your medical billing in-office as well as for telemedicine billing. Read how.

Telemedicine billingRose Nierman’s online medical billing course series, Nierman CE+ and her live cross-coding continuing education courses have helped thousands of dental practices learn and apply medical billing. Her company, Nierman Practice Management, created DentalWriter™ software to generate medical claims and narrative reports, and Nierman Medical Billing Service to handle the insurance communication for clients. Rose and her company have been dedicated to helping dentists and their teams for 32 years. For more information: or 800-879-6468.

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