Urology Coding Alert

Question: How could we bill for the pre-renal education for the dietitian? My understanding is that the dietitian education is not billable by the dietitian or the dialysis unit, but that the physician can do a referral for diet instruction and bill for that instruction from the physicians office. Is this correct, and if so, is it only a nurse code of 99211?

Montana Subscriber

Answer: For Medicare purposes, the time spent by a dietitian providing counseling and/or educating the patient cannot be counted toward the physician service, as stated in section 15501C of the Medicare Carriers Manual. Medicare guidelines state that the time spent in counseling and/or coordination of care is counted only when provided by a physician. Additionally, reimbursement for diet education provided to an end stage renal disease (ESRD) patient is included in the monthly capitation payment and is not reimbursed separately.

Therefore, when education services are provided by a dietitian employed by the physician, and the patient is non-ESRD, CPT code 99211 (minimal office visit) must be reported. Note that this may not necessarily be true for other, non-Medicare payers. It is recommended that the practice contact individual payers for coverage and coding guidelines.

Answers to Reader Questions and You Be the Coder contributed by Ray Painter, MD, president, PRS, Denver; Sandy Page, CPC, CCS-P, co-owner, Medical Practice Support Services, Denver; Laura Siniscalchi, RHIA, CCS, CCS-P, CPC, education coordinator for coding, Beth Israel Deaconess Medical Center, Boston.