Wiki Diabetic Education Classes

[coding4fun]

I am looking for guidance on proper billing for Diabetic Education classes which are currently being held at our facility. These classes are spearheaded by our Pharmacy department and have several speakers to include a physician who speaks on the medical ups and downs of the condition, a nutritionist who speaks on proper diet, a wellness coach who speaks on exercise and other ways to stay active and the 2 hour session is ended by the pharmacy who speaks about the different medication and how they effect lifestyle habits and encourages changes. We are currently billing a 99213 (because this class contains our established patients). Is there any other cpt coding choice which we could utilize to better capture this scenario? I do recognize that our Medicare does not cover the G code, therefore would place out to pt resp. The 99213 would, of course, would be responsible for copay & deductibe (if not met).

Any help would be greatly appreciated!

 

[erjones147]

One thing you could try (assuming the nutritionist is present for the entire meeting) is to bill using 97803 or G0271 for Medicare patients

Medicare WILL pay for a G0271 under the following conditions:

1) the billing provider is a nutritionist enrolled with your MAC

2) the ordering provider is a MAC-enrolled medical provider who saw the patient for diabetes AND referred the patient to receive nutrition services

3) the patient is obese/morbid AND has a documented BMI of >25 AND has ESRD/CKD or diabetes

Example:

E66.01
Z68.42
E11.22
N18.3

G0271 w/ quantity in 30 minute increments

 

[thomas7331]

I am looking for guidance on proper billing for Diabetic Education classes which are currently being held at our facility. These classes are spearheaded by our Pharmacy department and have several speakers to include a physician who speaks on the medical ups and downs of the condition, a nutritionist who speaks on proper diet, a wellness coach who speaks on exercise and other ways to stay active and the 2 hour session is ended by the pharmacy who speaks about the different medication and how they effect lifestyle habits and encourages changes. We are currently billing a 99213 (because this class contains our established patients). Is there any other cpt coding choice which we could utilize to better capture this scenario? I do recognize that our Medicare does not cover the G code, therefore would place out to pt resp. The 99213 would, of course, would be responsible for copay & deductibe (if not met).

Any help would be greatly appreciated!

Billing 99213 for group classes is incorrect coding and almost certainly not compliant - I highly recommend your facility pause this practice and reassess what you are doing at this could put you at a serious audit risk.

Diabetes Education (also called DSMT or diabetes self management training), is a Medicare covered benefit when provided by an accredited program. These services are to be billed with HCPCS codes G0108 (individual) and G0109 (group). I've included a link below to the section of Medicare's web site that addresses this. If your facility wishes to establish a program for this, there is an accreditation process through the ADA or the AADE, to which the site below has links, that is required before you can bill Medicare for these services. The ADA and AADE sites also have good information on the requirements and coding and billing rules for these programs. The Medicare Benefit Policy Manual, Chapter 15, section 300 also goes into extensive detail about the requirements for this program.

https://www.cms.gov/Medicare/Provid...cationGenInfo/DSMT-Accreditation-Program.html

I was recently involved with a program that underwent a long and difficult period of Medicare pre-pay audits for proper documentation for the billing of DSMT services and I can attest that they are very rigorous and attentive to detail in making sure that providers adhere closely to each and every one of the requirements specified by Medicare for these programs. As a covered benefit, you cannot simply bill these to your Medicare patients in every case that Medicare will not pay. I would suggest that your facility take a close look at all of the available information and work with the diabetes organization to make sure that you are compliant as well as appropriately reimbursed for the services.