Primary Care Coding Alert

Question: A patient seen for diabetes (250.02) in the doctor’s office and the physician provides diabetes management training for the patient. What codes can be used for the education using CPT® and HCPCS?

New York Subscriber

Answer: You can report the management training provided to the patient using the HCPCS code G0108 (Diabetes outpatient self-management training services, individual, per 30 minutes). The individual code, however, requires a minimum of 30 minutes and is reported in one unit of code for every 30 minutes of management training services provided. So if your FP provided an hour of individual DSMT, you would report G0108 x 2.

Instead of providing these services individually to the patient, if your FP provides diabetes management training services to a group, you’ll report G0109 (Diabetes outpatient self-management training services, group session [2 or more], per 30 minutes).

You can also consider using 99078 (Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting [e.g., prenatal, obesity, or diabetic instructions]) for providing diabetes management instructions in a group setting. This code is not time-based and can be coded per patient. However, not all payers reimburse for 99078, so check guidelines before making assumptions regarding payment. For instance, Medicare considers it a “bundled” service.

Note: You cannot use the CPT® codes 98960-98962 (Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient…) for reporting the DSMT. These codes are reported when the service is provided by a qualified, non-physician health care professional. Since, in your case scenario, the DSMT was provided by your FP, it cannot be reported using 98960.