Primary Care Coding Alert

Question: We are getting a denial on 97803 saying that it needs a modifier. What modifier should we use?

AAPC Forum Participant

Answer: Assuming that no other services were provided at the time, your payer may be asking you to use a provider modifier on 97803 (Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes). Depending on the nature of the medical nutrition therapy (MNT) counseling, and the qualifications of the person providing it, that could be a Level II modifier such as SW (Services provided by a certified diabetic educator) or AE (Registered dietician).

Why? CPT^® contains a parenthetical instruction following the code that states “physicians and other qualified health care professionals who may report evaluation and management services should use the appropriate evaluation and management codes” for MNT. Similarly, Medicare guidelines require that “a Registered Dietitian or nutrition professional who meets certain requirements can provide MNT services”

(Source: www.medicare.gov/coverage/nutrition-therapy-services.html).