CODING CORNER: Master Medical Nutrition Therapy With These Tips

Example: Check with private payers before billing G codes
As the number of Americans with diabetes continues to grow, so does the demand for nutrition and diabetes education services. Secure the maximum reimbursement for these sessions with this expert strategy.

Avoid Incident-To Reporting for These Services
The CPT codes for medical nutrition therapy cannot be paid incident-to physician services, says Terry Byrne, CPC, of Terry Byrne, CPC, Inc. in Brunswick, Ga.

Registered dieticians or nutrition specialists who have their own UPIN or NPI and meet specifications set by the Centers for Medicare & Medicaid Services can report these codes and then reassign payment to an employer, she says. These codes are billable for patients with diabetes or renal disease when referred by a physician, Byrne says.

Use 97802 (Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes) for the initial assessment. Bill 97802 in 15-minute increments and only bill it once per year, Byrne says.

Report 97803, also billable in 15-minute increments, for reassessment and intervention. Reserve 97804 (… group …), billable in 30-minute increments, for group visits of two or more patients.
Look to HCPCS Codes for Accredited Programs
If your facility has an accredited American Diabetes Association (ADA) or Indian Health Service (IHS) diabetes self-management training (DSMT) program, you can bill HCPCS codes G0108 and G0109, without any reassignment by the registered dietitian or certified diabetic educator, Byrne says.

Codes G0108 (Diabetes outpatient self-management training services, individual, per 30 minutes) and G0109 (… group session [2 or more], per 30 minutes) can be billed during the same time period as 97802-97804 to patients diagnosed with diabetes, but the services may not be provided on the same day to the same patient, Byrne says.

Tip: While the G codes are specific to diabetes training, not all private payers recognize them. Try contacting your private payers to see if they will accept these Medicare-recognized G codes, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

If you can’t get any information from the private payer about whether these codes will be accepted, try billing the private payer and see how it’s processed, Cobuzzi says. If the claim is not processed correctly, you’ll have to rebill for it, she says.

Keep the following guidelines in mind when billing for diabetes nutrition therapy, Byrne says:

• Medical nutrition therapy services are not covered for patients receiving maintenance dialysis for which payment is already made.

• You cannot bill patients for MNT and DSMT on the same day.

• Include an ICD-9 diagnosis code that indicates your patient’s type of diabetes when billing for MNT.

• Coverage is defined [...]

- Published on 2006-11-09