Part B Insider (Multispecialty) Coding Alert

Also:  If you don't include a diabetes diagnosis on your claim, expect a denial

Scenario: You're using the correct medical nutrition therapy /diabetes self-management training (MNT/DSMT) code and associated PIN to report your practice's diabetes counseling services, but Medicare is still denying claims.

Solution: Double-check your carrier's coverage limitations.

"Medicare allows a one-hour initial MNT visit and two hours of follow-up, following the initial visit in the first year," says Reinhard Wolfgang Beel, CEC, business manager at Cumberland Valley Endocrinology Center LLC in Carlisle, PA. Carriers cover two hours of follow-up MNT annually.

You can expect lengthier coverage of DSMT, however. In addition to MNT hours, "Medicare allows a one-hour initial DSMT visit and 10 hours of group sessions" in the first year, Beel remarks. In subsequent years, "An eligible beneficiary with diabetes will be allowed ... up to two hours of follow-up DSMT annually," according to the American Diabetes Association.

Tip: Medicare may still cover diabetes education and nutrition counseling even when the patient has exceeded the above frequency allowances. "When the patient has a change in status, such as insulin, and the MD orders MNT services beyond the original benefit inclusions, you should report G0270-G0271," Latanick says.

Don't forget: To ensure diabetes education coverage, you must include a covered ICD-9 diagnosis . "The patient must be a diabetic," Latanick says.

Action: Assign the appropriate five-digit number from 250.00-250.93. Medicare considers nutrition counseling appropriate for any diabetes mellitus diagnosis in the 250.xx series, as well as gestational diabetes according to the Medicare Part B Reference Manual, Chapter 13, Section 13.8. DSMT is covered for "Medicare beneficiaries at risk for complication from diabetes or recently diagnosed with diabetes," CMS states.

Note: For more information on coding MNT and DSMT, view the ADA's FAQs at www.diabetes.org/for-health-professionals-and-scientists/recognition/dsmt-mntfaqs.jsp#Q5.