I am new to billing Nutritional Counseling. We have a registered dietician providing the service. Our patient's are referred to her by our endocrinology clinic as well as family practice clinic. I am confident we are billing the correct CPT's (97802 and 97803) we are not doing group at this point. My issue is that some of the insurance carriers are denying because the dietician is not credentialed. When we call we are told the carrier does not credential dieticians. So how are we to bill and get paid for this service when the patient has the benefit? I am at a loss. Is it appropriate to bill as incident to? we are getting an order from the physician just not sure what we are doing wrong. Any assistance would be greatly appreciated.
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Wiki Nutritional Counseling
- Thread starter cmicho
- Start date
TThivierge
True Blue
Hi Cmicho
Here are my thoughts...the referring MD can be listed on the OP claim but first documented on patient's medical record referred to dietician due to Obesity or DM or HTN or CHF Etc health problem. You can bill CPT 92111 since the dietician is QMHP staff or once see pt face to face can do phone calls with CPT 98966 ensure add minutes in documentation and permission to call pt as follow up visits on this medical record. Pt see MD first, then next half hour go see the dietician on same date. Use modifier 25 per payer guidelines; 2 separate claims transmitted or combo claim. Check with payer see if valid to do this type of care.
I d try using still CPT 97802 series with referral doc name on claim and in notes; maybe do preauthorization check. CPT 99211, CPT 99401-99412 (add minutes of therapy and describe how help/assist in diet) or CPT 97535 per 15 minutes CPT 96156 or 96157 but not with other Eval/mgnt CPT codes. Telehealth phone calls CPT 98966-98968 or 98970 series online email to patient-ensure get pt permission verify on med record for the day and add time discuss with pt. Also add if communication is a phone call vs online Zoom visit in med record notes for the day. Add modifier 95 to other CPT codes. Ensure documentation relays describe, pt weight, dx Z68 match body weight with dx E66 blocks (E63 and E66 R63, R26 dx blocks) and or dx Z71.3 last on claim. Outline pt s problem s with dx related to health problems defined by the attending or referral family doctor DM, CHF, G47 Sleep Problems, Stress F43, F32 depression, M10 Gout, Arthritis M15 or M19, M54 Back Pain, Etc. Add exercise suggestions with dx Z71.82 to help weight loss. Ensure at least 15 minutes of care and put in notes for the day.
Well I hope these alternate CPT will be helpful for the dieticians.
Lady T
Here are my thoughts...the referring MD can be listed on the OP claim but first documented on patient's medical record referred to dietician due to Obesity or DM or HTN or CHF Etc health problem. You can bill CPT 92111 since the dietician is QMHP staff or once see pt face to face can do phone calls with CPT 98966 ensure add minutes in documentation and permission to call pt as follow up visits on this medical record. Pt see MD first, then next half hour go see the dietician on same date. Use modifier 25 per payer guidelines; 2 separate claims transmitted or combo claim. Check with payer see if valid to do this type of care.
I d try using still CPT 97802 series with referral doc name on claim and in notes; maybe do preauthorization check. CPT 99211, CPT 99401-99412 (add minutes of therapy and describe how help/assist in diet) or CPT 97535 per 15 minutes CPT 96156 or 96157 but not with other Eval/mgnt CPT codes. Telehealth phone calls CPT 98966-98968 or 98970 series online email to patient-ensure get pt permission verify on med record for the day and add time discuss with pt. Also add if communication is a phone call vs online Zoom visit in med record notes for the day. Add modifier 95 to other CPT codes. Ensure documentation relays describe, pt weight, dx Z68 match body weight with dx E66 blocks (E63 and E66 R63, R26 dx blocks) and or dx Z71.3 last on claim. Outline pt s problem s with dx related to health problems defined by the attending or referral family doctor DM, CHF, G47 Sleep Problems, Stress F43, F32 depression, M10 Gout, Arthritis M15 or M19, M54 Back Pain, Etc. Add exercise suggestions with dx Z71.82 to help weight loss. Ensure at least 15 minutes of care and put in notes for the day.
Well I hope these alternate CPT will be helpful for the dieticians.
Lady T
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