Pediatric Coding Alert

Question: We recently hired a registered nurse who is a Certified Diabetic Educator. However, we are a pediatric practice, not a diabetic education center. Which code should we use to charge for her services? Would G0108 work?

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 (such as 250.01, Diabetes type I, controlled or 250.03, Diabetes type 1, uncontrolled) would be preferred.

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.