Wiki Diabetes Education Coding...

[kayba89]

Okay guys, my office has been handed some confusing information from other coders within the organization, as well as billers, that we would like some other feedback on.

We are a nonprofit community clinic.

We offer diabetes education. Our educator, though, only has a bachelor degree. We have been told we can still code for her as long as the physician signs off. If you agree, what would you code as? 99211 or an MNT with a mod?? Or, do we not even code for her??

If you disagree, why?

 

[SharonCollachi]

Here is information about diabetes education coding and billing, for INDIVIDUAL education. Medicare, for example, only covers individual education when there is a medically necessary reason that the patient cannot do group education. Also, the educator/program must be accredited by one of several agencies, in diabetes management.

This info is a bit older, and I haven't checked the codes: Contact each of the private payers to see if they require a DSMT program to be recognized by the ADA or by any other accreditation organization. Many private payers do not require ADA recognition, or any other kind of accreditation. They may also want you to use CPT codes 98960 for an individual for each 30 min.

 

[kayba89]

Thank you! I will bring this to the attention of staff here so we can make the best decision.

Here is information about diabetes education coding and billing, for INDIVIDUAL education. Medicare, for example, only covers individual education when there is a medically necessary reason that the patient cannot do group education. Also, the educator/program must be accredited by one of several agencies, in diabetes management.

This info is a bit older, and I haven't checked the codes: Contact each of the private payers to see if they require a DSMT program to be recognized by the ADA or by any other accreditation organization. Many private payers do not require ADA recognition, or any other kind of accreditation. They may also want you to use CPT codes 98960 for an individual for each 30 min.