Oncology & Hematology Coding Alert

Question: We often use a nutritionist to advise patients on their diet. She is employed by our practice. Can we get paid for her services?

Nebraska Subscriber

Answer: Unfortunately, as necessary as these services are, they are not billable. However, because the dietitian is employed by your practice, a visit with the nutritionist could be billed as a low-level E/M, 99211(office or other outpatient visit), similar to billing for the services of an RN or LPN employed by a practice. The level-one visit is an "incident to" service and is billable to Medicare only if a physician is physically present in the office suite and available to provide immediate assistance. The involve-ment of the physician and the other elements necessary to justify that visit need to be documented by the dietitian. 
 
An example of physician involvement is an order or consult for the patient to see the dietitian, and/or a note by the dietitian of a conversation she or he had with the overseeing physician during the patient's visit.
 
Note: Medical nutrition therapy (97802-97804) is covered under Medicare Part B but is limited to beneficiaries who have diabetes or renal disease. In 2003, other conditions will be considered for inclusion, but until then coverage is not applicable for typical oncology patient needs.