Wiki Licensed Dieticians/Nutritionists Not Getting Paid....Why???

[wbrodsky]

I have a couple Licensed Dieticians and Nutritionists who never get paid by the insurance carrier for Dietary Counseling, by any insurance carrier, unless the pt also has Diabetes but even then sometimes it still denies. The denial states that they are not eligible providers for the services provided. I am wondering if there is something we are doing wrong in coding these. We have tried everything in rearranging the Dx codes and each time they deny. Does anyone else have experience with this that can offer advice? OR is this just how it is?

 

[erjones147]

Depends which insurance you are talking about

Can't help with Medicaid since we bill AIR, not FFS

I have had great success getting privates to pay using the appropriate 97802/97803/97804 codes. Primary dx does not seem to matter, as long as it's not something like "pain in right hallux." YMMV. If it's privates who are killing you the most, msg me and we can work it out. I definitely can feel your pain (flashes back to 2013 and winces)

Medicare is a lot trickier. The patient MUST be obese (primary dx) AND have a listed BMI of at least 25 for people not of Asian descent AND have either DM or CKD/ESRD. Billing is under G0270/G0271 under a Medicare-registered dietitian as the rendering AND a Medicare-registered medical MD/DO/FNP, etc. as the ordering provider (which in turn implies a referral of some sorts)

Hope this helps