EM Coding Alert

Question: What CPT^® and ICD-10 codes should we be using for diabetes education our physician provides in the office? We have the patient come back to meet with our diabetes specialist to learn how to control his diet, self-test his sugar levels, and self-inject insulin.

Hawaii Subscriber

Answer: You can report the training provided to the patient using the HCPCS code G0108 (Diabetes outpatient self-management training services, individual, per 30 minutes). The individual code, however, requires a minimum of 30 minutes and you’ll report one unit of code for every 30 minutes of management training services provided. So if your specialist provided an hour of individual diabetes self-management training (DSMT), you would report G0108 x 2.

Instead of providing these services individually to the patient, your practice may provide diabetes management training services to a group. In that case, you’ll report G0109 (Diabetes outpatient self-management training services, group session [2 or more], per 30 minutes) instead of G0108.

Alternative: You can also consider using 99078 (Physician or other qualified health care professional qualified by education, training, licensure/regulation [when applicable] educational services rendered to patients in a group setting [e.g., prenatal, obesity, or diabetic instructions]) for providing diabetes management instructions in a group setting. This code is not time-based and can be coded per patient. However, not all payers reimburse for 99078, so check your payer’s guidelines before making assumptions regarding payment. For instance, Medicare considers it a “bundled” service.

Watch out: You cannot use the CPT^® codes 98960-98962 (Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient…) for reporting the DSMT. These codes are reported when the service is provided by a qualified, non-physician health care professional. Since, in your case scenario, the DSMT was provided by your FP, it cannot be reported using 98960.

Diagnosis help: As for the ICD-10-CM code, it would depend on the patient’s current condition. If the patient has just been diagnosed with type II diabetes then a code from the E11.9___ section of ICD-10. If, however, the patient is type I and needs additional counseling or training, you should explore the E10.9___ section of ICD-10 for the proper code. Make certain you are completing the code to best illustrate the patient’s relevant condition.

Your diagnosis coding will also depend on the type of counseling your specialist is providing. Consider using Z71.89 (Other specified counseling) and/or Z71.3 (Dietary counseling and surveillance) in addition to the diabetes code illustrating the true condition of the patient.