# Medicare covers screening and counseling for obesity



## perkins05

Medicare annouced they will cover screening and counseling for obesity in primary care offices? What CPT and ICD9 can be used?

CPT
G0270 and G0271 
97802 97803

Dx 

V85.** or V65.3
278.00

All responses are appreciated 


Thanks


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## jharrell

I am currently waiting for them to come out with codes as well.  In the CMS memo someone asked what the codes would be and CMS response was they are currently creating CPT codes for the obesity counseling.  Hopefully we will know soon.

Jessica


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## perkins05

Thanks


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## KellyLR

*Obesity coding*

Hello Everyone,

Have the physician document the obesity.  "Morbid obesity" requires a BMI of >40

I have worked with physician documentation of obesity recently because of all the new buzz and I just train the physicians to document the type of obesity and BMI status.  Also need to document what, how they are treating the patient with obesity diagnosis.

278.00 is a BMI between 30-39.9 that's where most fall.  They key is documentation.

It helps HCC risk adjusters to have the BMI and a Morbid obersity code or it won't adjust, dependfing on their risk schedule.

Hope this helps


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## ttcoding

*screening for obesity*

New HCPCS codes for screen for obesity (G0447 and G0449)

If you billed these codes G0447 or G0449 with a wellness visit or an office visit would the office visit or prevent get bundled to G0447/G0449?


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## vickywm1 

*About correct CPT and DX codes to use for obesity counseling/screening*

I know that Medicare/CMS recently approved to pay for obesity counseling and screening, but does anyone know when this will take effect?  I have been looking online, but have not found a specific effective date.  Also, do anyone know the procedure codes and dx codes that will be used.  Please respond.  Thanks!


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## perkins05

Hi Jessica I found this today...

Effective Date: January 1, 2012


https://www.cms.gov/MLNMattersArticles/downloads/MM7668.pdf
or
http://heartandhealth.com/news/


Thanks everyone for your responses


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## mitchellde

perkins05 said:


> Hi Jessica I found this today...
> 
> Effective Date: January 1, 2012
> 
> 
> https://www.cms.gov/MLNMattersArticles/downloads/MM7668.pdf
> or
> http://heartandhealth.com/news/
> 
> 
> Thanks everyone for your responses



Is this the correct link for Med Learn?  it is an article on OPPS for the comming year.


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## Pam Brooks

That's not the correct link; it's for OPPS.  There are Medlearn matters articles for Depression, ETOH and CVD screening HCPCS codes.  Still waiting for guidance for the Obesity screening.


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## mitchellde

Thanks Pam, I have been looking and waiting for this as well, let me know when you get something, I will do the same.  Thanks again!


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## vickywm1 

*Thanks everyone*

Thanks everyone for the info.  It is appreciated.  Please keep sharing the info as it becomes available.  Vicky


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## Pam Brooks

Hi, all.  Had an "Ask the Contractor Conference" with our local carrier, NHIC yesterday.  the MedLearn Matters article on Obesity screening is forthcoming, but they did acknowledge that it's not out yet.  (although we are supposed to be able to bill for it next week.....).

As soon as I see it, I'll post the link.  Happy New Year to All!  Pam


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## perkins05

Thanks Pam! Happy New Years!


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## Pam Brooks

According to 2012 HCPCS, here are the screening codes:

*G0442*, Annual alcohol misuse screening, 15 minutes

*G0443* Brief-face-to-face behavioral counseling for alchohol misuse, 15 minutes. See CMS 100-04-Chapter 18, 180.1-180.5 for details.
No MedLearn Matters article on this yet.

*G0444* Annual Depression Screening, 15 minutes. See Medlearn Matters MM7637 for details

*G0446* Intensive Behavioral Therapy to reduce CVD Risk, bi-annual, 15 minutes. See MedLearn Matters MM7636.

*G0447* Face-to-face behavioral counseling for obesity, 15 mnutes
*G0449* Annual face-to-face obesity screening, 15 minutes (no current MLM article on these two, as of this a.m.). 

Also new is the *G0445*, high intensity behavioral counseling to prevent Sexually transmitted infections, bi-annually for 30 minutes. I haven't seen a MLM article on this, but I haven't really looked....anyone? 

I don't have a fee schedule or RVUs for these yet...does anyone have this info? This will determine whether my docs want to build EHR templates to support the billing of these kinds of visits. ROI, and all of that, you know! 

Pam


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## Pam Brooks

Here's the decision memo for Screening for STIs and high-intensity behavioral counseling....

https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=250

No MLM articles on this or the obesity yet.


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## rthames052006

*Med Learn Matters MM7633*

Just thought I'd chime in on this as I am actually working on this issue as we speak, reviewing etc...

There is a MedLearn Matters article on the Annual Alcohol Misuse, 15 minutes G0442 and Brief face-to-face Behavioral Counseling Interventions, 15 minutes G0443.

http://www.cms.gov/MLNMattersArticles/Downloads/MM7633.pdf


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## bedwards

This just in...G0449 has already been deleted-see below-

HCPCS code G0447 has been assigned to APC 0432 and given a status indicator assignment of “S.” Further reporting guidelines on intensive behavioral therapy for obesity will be provided in a future CR.
CMS is deleting screening code G0449 (Annual face to face obesity screening, 15 minutes) previously released on the 2012 HCPCS tape, from the OPPS addenda, effective November 29, 2011. This screening service will now be identified using ICD-9 screening and diagnosis codes. Coding and billing instructions will be issued in an upcoming CR.

http://www.cms.gov/transmittals/2011trans/itemdetail.asp?itemid=CMS1255229


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## Pam Brooks

Thanks, Brenda.  If you see the CR, can you let us know?
Pam


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## bedwards

Will do!


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## dballard2004

Perhaps I have missed something, but in reading through all the MLN Matters Articles and the CMS Transmittals on all of these new services, there is only mention of the HCPCS G codes to report.  I find nothing on what ICD-9-CM codes we are to report for these services.  Does anyone know what ICD-9-CM codes we are to use?  Did I miss this info somewhere?


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## bedwards

I cannot find anything on CMS that specifically addresses the ICD-9-CM codes to be used.  

I would suggest V65.3-dietary surveillance and counseling (which includes obesity) and V85.3_ or V85.4_ to report the BMI. 

Keep in mind there may be policies that will be specific to a Medicare intermediary so you will need to check with your local carrier.


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## dballard2004

Thanks.  I spoke with one of the MAC carriers that I deal with and they could not provide me an answer.  It appears that Medicare has not made an official determination on the ICD-9-CM codes for these services as of yet.


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## daharden

What about CPT codes?  Will these be billed as office visits?  

Thanks,
Debbie


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## Pam Brooks

daharden said:


> What about CPT codes? Will these be billed as office visits?
> 
> Thanks,
> Debbie


 
Since the other screening coverage (CVD, ETOH, etc) have been assigned G-codes, (see 2012 HCPCS and the links above to the LCDs) and the G0449 for obesity screening was apparently deleted, I can tell you that it will likely be a G-code, not an E&M code from CPT.  We're waiting for the LCD to come out for the final answer on Obesity.


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## 727EASTAVE

*Any updates*

Has anyone seen any updates re: the coding for the Obestiy screening yet?


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## apache069

*What codes insurance companies will accept*

Hello Everyone,

Since Medicare has not officially come out with the codes for obesity screening and counseling, I am trying to find out what codes different insurance companies (Humana,Anthem etc.) are accepting for payment of screening and counseling for obesity but I am having the hardest time doing so. Can anyone give me any tips,help on where on these ins company websites I can find out such info? Or should I just call the ins company directly? Any help on this would be greatly appreciated. Thanks


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## Pam Brooks

I participated in a recent (12/28/2011) Ask the Contractor Conference sponsored by NHIC (contractor for ME, NH, VT, MA).  I asked about the codes for Obesity Screening.  Here's their answer.  

*Q10.* [FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]I am unable to locate information regarding obesity screening and coverage. There are no G-codes or diagnosis codes currently listed that would be appropriate to use. 
[/FONT][/FONT]*A10. *[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]On November 29, 2011, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare is adding coverage for preventive services to reduce obesity. However, at this time CMS has not released the applicable codes to report this service. As soon as NHIC, Corp. receives that information from CMS, we will post to our website. 
[/FONT][/FONT]*Reference: 
*[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]http://www.medicarenhic.com/providers/articles/CMS%20Message%20201111-71.pdf 
[/FONT][/FONT][/FONT]


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## dballard2004

Medicare has released the codes (HCPCS and ICD-9-CM) that are to be used for this service:

http://www.cms.gov/MLNMattersArticles/downloads/MM7641.pdf

I would recommend consulting with your Medicare carriers for their guidance.


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## Pam Brooks

Dawson, the MLM article you are referencing is the guidance for the obesity counseling.  

We're still trying to identify the codes and guidance for the obesity screening.  


Just wanted to clarify, because they're two different services.


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## dballard2004

Pam,

From what I gather, the screening is part of the obesity counseling.  Per the MLM article, IBT for obesity includes an obesity screening.


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## caroline75771

Medicare has now revised Intesive Behavioral Therapy (IBT) for Obesity, which now services can be furnished by auxiliary personnel.  Our physicians are considering to have the dietitians to provide the service.  
So I would like to know if dietitans bill under their own number will claim deny because of speciality type according to Medlearn guidance only stated specialty types will be eligible to perform service.  Therefore, we should probably bill under the physicians number and internal medicine speciality.

Any suggestions??
Thank you,
Caroline


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## efuhrmann

I don't "see" registered dieticians as an acceptable specialty type for the IBT for Obesity.


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## caroline75771

Our dieticians would be considered auxiliary personnel.


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## efuhrmann

MM7641 has a list of provider specialty types that will be reimbursed for G0447.  Registered dieticians are not on the list.  Nurse Practitioner, Certified Clinical Nurse Specialist and Physician Assistant are the auxillary providers that are eligible.


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## caroline75771

I diagree NP, CCNS, PA are some of the providers speciality types claims will be paid, however, with the new revision auxillary personnel according to Medicare's Incident-to guidelines "Auxiliary personnel means any individuals  who is acting under the supervision of a physician, regardless of whether the individual is an employee, leased employee, or independent contractor of the physician, or of the legal entity that employs or contracts with the physician. 

We have decided based on the incident-to rule were going to have the dieticitans provide the service under the supervision  of the internist and bill under the internist number providing incident-to requirements are met.


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