Pediatric Coding Alert

Question: We have a pediatric endocrinologist on staff, and his nurse performs diabetes education with some patients. We're trying to bill these visits using G0108 with the diagnosis code V58.67. Is this appropriate?

Michigan Subscriber

Answer: Code G0108 (Diabetes outpatient self-management training services, individual, per 30 minutes) is a Medicare code used for diabetes education. Some private payers and some state Medicaid programs also recognize the code or have their own specific codes for nurse diabetes education. The V58.67 (Long-term [current] use of insulin) diagnosis would be appropriate to report with this code. However, the other diabetes ICD-9 codes (250.01, Diabetes type I, controlled or 250.03, Diabetes type 1, uncontrolled) would also be appropriate as well.

Another consideration would be using the nurse E/M visit code (99211), with careful documentation of the medical necessity and time involved in the diabetes education. This would be an "incident to" service linked to the standard diabetes ICD-9 code (such as 250.01 or 250.03). Another series to consider, although poorly recognized by payers, are the codes for Education and Training for Self-Management: 98960-98962, which also includes small group education. 98960 would be the individual patient education code.