# E/M visits by a nutritionist??



## krisfelty (May 27, 2011)

I have a question. Can a nutritionist bill an E/M service (99213-99214) for talking to a patient regarding their diet. No exam , no ROS, no MDM except for a diet revision?? Dr signs bottom of note stating seen and agreed?? To my knowledge , this is wrong. 
Can anyone else please give me their input....


Thanks, 

Kris


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## hewitt (May 27, 2011)

There is not enough detail to suggest a specific CPT, but you might want to review the Preventive Medicine codes. Is the Registered Dietitian providing education and counseling for wellness and disease prevention and diabetes self-management training?


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## Dee Dee Pilette (Jun 4, 2012)

*Registered dietitian*

I have been told a registered dietitian can bill under the "incident to" with an E/M code.   The physician sees the patient first to make the recommendation.   The dietitian is in the same practice.  The patient is usually seen on the same day as the physician, just following the appointment.  Usually a prolonged visit comes into play with the new patients appts. Sometimes though, this is not possible and the patient is seen on another day.  I have been told to bill time spent with the patient.    The two practies I work with are lipid and bariatric.      I would appreciate your advice.


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## mitchellde (Jun 4, 2012)

There are specific nutrition codes in the medicine section.  No a nutritionist may not bill using visit levels and time spent for the physician levels must be physician to patient face to face not ancillary personnel time.  You bill using the appropriate nutrition codes.


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## Dee Dee Pilette (Jun 6, 2012)

I received a newsletter from the Academy of Nutrition and Dietetics were it states federal regulations under 42 CFR 410.26.   These patients are being seen at the physicians request due to 278.01 (Bariatric) or 272.2 (Lipid).   Do you think this regulation would apply to a physician's office where a dietitian is being used?


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## bedwards (Jun 6, 2012)

The CPT guidelines at the beginning of the E/M section clear define who may use those codes. Unless the nutritionist is a mid-level, they cannot bill those services. As Debra mentioned, there are codes in the medicine section for the nutritionist.


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