Pediatric Coding Alert

Question: Our dietician reviews electronic food logs sent in remotely on a weekly or monthly basis by patients on supervised diets. As the encounter is not face-to-face, would it be more appropriate to use 99091 rather than 97803 to record the encounter?

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Answer: Yes, you are making the correct code choice in this situation. In its descriptor, 97803 (Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes) stipulates that it is to be used for face-to-face encounters. If your dietician’s patients are just uploading data for review, and your dietician is not meeting with them either in your office or via synchronous audio or video communication, then this code is not applicable, even if it is on CPT^®’s telehealth code list.

Instead, 99091 (Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days) would be the appropriate code to use as the service is asynchronous, meaning that your dietician is reviewing the data without the patient being present, either in person or via telecommunication.

However, before you use the code, you will need to make sure you follow a number of CPT^® guidelines. First, CPT^® states that “if the services described by code 99091 are performed on the same day a patient presents for an E/M service, these services should be considered part of the E/M service and not reported separately.” Second, per the code’s descriptor, you will only be able to report the code once every 30 days. Finally, also per the code’s descriptor, the service provider must be licensed and be able to bill under their own name and ID.

Coding note: If you do use this code, make sure your dietician documents the amount of time spent collecting and interpreting information from the patient’s log. As the descriptor states, the review needs to take a minimum of 30 minutes.