Primary Care Coding Alert

Question: Our PCP recently gave nutrition counseling to a Medicare patient. We used F50.02 with 97803, but we were denied with the reason that our “provider may not perform this type of service.” What did we do wrong? Should we have used Z71.3 instead?

Codify Subscriber

Answer: The issue here is not the diagnosis codes. F50.02 (Anorexia nervosa, binge eating/purging type) is a perfectly acceptable diagnosis to accompany medical nutrition therapy (MNT), and encounter code Z71.3 (Dietary counseling and surveillance) is also appropriate.

The issue surrounds the qualifications of the provider who performed the services outlined in 97803 (Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes). CPT^® contains a parenthetical instruction following the MNT codes that states “physicians and other qualified health care professionals who may report evaluation and management services should use the appropriate evaluation and management codes.” Similarly, Medicare guidelines require that “a Registered Dietitian or nutrition professional who meets certain requirements can provide these services.” (Source: www.medicare.gov/coverage/nutrition-therapy-services.html).

So, unless a registered dietician or a credentialed nutritionist provided the service to your patient, you cannot bill for 97803 when provided by your physician. The only role your provider should have in the service should be in the referral to the nutritionist.