Revisiting G0047 obesity counseling

[ollielooya]

List, I did not get any answers to a prior submitted question, so will try again:
Simple 2 part question from doctor, but not sure how to handle it. Have the
MLN# MM7641 in front of me and doctor has it as well.

#1)BMI # 30 or greater must be on the initial visit? (yes!)
#2) As the BMI drops below 30 the billing still applies (???)
So once the patient's BMI has decreased from the threshold that was required to utilize this code, then how should subsequent visits be considered? Regular EM follow up visits? New type of billing to us.

Just looking for a good way to respond to the doctor that will be more
than just a "yes" or "no" answer on question #2.

Suzanne E. Byrum CPC

[hewitt]

I would say you have to determine which CPT to use per the "chief complaint" for the visit in question. Is it for Nutrition Counseling? Managing a systemic problem (DM, HTN)? Making sure that the patient is staying to the agreed plan? Documentation requirements for whichever CPT you decide to use will have to be followed as well. What was/is the reason for the initial counseling?

[hewitt]

I was curious about this, so did some research.... Here is the Medicare guideline for using this CPT.
http://www.ngsmedicare.com/wps/wcm/c...e=&savecookie=

[ollielooya]

Thank you so much for taking some time to do some research. Somedays I find myself doing the same thing when I'm answering replies from others and appreciate your input. I do have that article and had it in front of me when I posted the initial question, plus the doctor has a copy as well. It just doesn't further address the question that he asked.......Probably will just go ahead and utilize the link in the "additional information" and ask. It's worth a try. ---Suzanne E. Byrum CPC

[hewitt]

I think it does address how to use this CPT. I scanned the article, but I think it says you can bill this code up to 22 times over a 6 month period as long as there is documented progress.

[hewitt]

Correction: It describes total number of visits allowed for a 12 month period or the allowed billing frequency for G0447, defines which ICD-9 codes to use, what CPTs are bundled or can be billed with the G0447, specialties that can bill the code, and place of service.

[caroline]

I have the same questions with regard to the BMI dropping below 30.
There's no straight answer but I found the same question asked at NGS-(our local Medicare) Preventive Services Webinar on 2/2/12:

If a patient starts out at a Body Mass Index (BMI) of 30 and loses weight to below 30. Are they still eligible for the obesity counseling benefit at that point?

Effective for claims with dates of service on or after November 29, 2011, Medicare beneficiaries with obesity (BMI ≥30 kg/m2), who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting are eligible for:
◦One face-to-face visit every week for the first month;
◦One face-to-face visit every other week for months 2-6; and
◦One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg (6.6 lbs) weight loss requirement during the first 6 months as discussed below.
At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss should be performed. To be eligible for additional face-to-face visits occurring once a month for months 7-12, beneficiaries must have achieved a reduction in weight of at least 3kg (6.6 lbs.), over the course of the first 6 months of intensive therapy. This determination must be documented in the physician office records for applicable beneficiaries consistent with usual practice. For beneficiaries who do not achieve a weight loss of at least 3kg (6.6 lbs.) during the first 6 months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.

I know this is not answering both of our questions, but I'm thinking the services are over however, if the patient is eligible for MNT services these are services that could be billed providing requirements are met.

Caroline