Internal Medicine Coding Alert

Published on Mon Jan 01, 2001 PDF

Question: How can our internal medicine practice report nutritional counseling provided by our certified diabetes educator, who is also a registered dietitian?

New Hampshire Subscriber

Answer: CPT 2001 contains the following three new medical nutrition therapy codes:

97802 medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes;

97803 medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes; and

97804 medical nutrition therapy; group (2 or more individual[s]), each 30 minutes.

These new codes are for use by nonphysician healthcare professionals. A note after these codes states that medical nutrition therapy assessment and/or intervention performed by a physician should be reported with a preventive medicine or evaluation and management (E/M) service code.

Whether these codes can be used to report nutrition counseling provided by a certified diabetes educator to a commercial payer will depend on the specific policies of that payer, according to Kathy Pride, CPC, coding supervisor for Martin Memorial Medical Group, a hospital in Stuart, Fla. However, it is unlikely that you will receive reimbursement from Medicare for these codes. For starters, Medicare has not assigned a relative value unit to any of these codes for 2001.

In addition, Medicare has established two HCPCS codes, which should be used to report diabetic education services, including nutritional counseling. Code G0108 (diabetes outpatient self-management training services, individual, per session) is used to report individual instruction sessions. Code G0109 (diabetes outpatient self-management training services, group session, per individual) is used to report the more common group instruction sessions.

To report these HCPCS codes, however, the diabetic education program that your practice provides must be certified by the American Diabetes Associations Education Recognition Program (ADA-ERP). The certification, which is based on standards identified by the national Diabetes Advisory Board, requires a program to have on staff both a registered nurse and registered dietitian. The application process requires an applicant to collect six months of data on its current diabetes patients, measure clinical outcomes and assess its patients knowledge of diabetes self-management. After the data have been compiled, the application and programs curriculum are subject to a peer review by experts in diabetes management and instruction.