Oncology & Hematology Coding Alert

Question: We are an office-based single-specialty group. I saw a code in the CPT book for medical nutrition therapy 97802. What is this code used for? Georgia Subscriber Answer: Medicare introduced coverage for medical nutrition therapy (MNT) services in 2002. Medicare now allows payment for MNT services when furnished by a registered dietitian or nutrition professional meeting certain professional standard requirements. Complete details of Medicare coverage for MNT appeared in spring and/or summer issues of Medicare newsletters published by carriers. In brief, MNT services are covered for certain beneficiaries who have diabetes or a renal disease, effective for services furnished on or after Jan. 1, 2002. Payment is made only to a registered dietitian or nutrition professional, only for beneficiaries who are not inpatients of a hospital or skilled nursing facility. The treating physician must make a referral and indicate a diagnosis of diabetes or renal disease, and MNT services must be provided by a professional, as defined in Professional Standards for Dietitians and Nutritionists. Nonphysician practitioners (e.g., CNSs, PAs, NPs) cannot make referrals for these services, and these services cannot be paid "incident-to" physician services. Payment is made using the following codes:

97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes. (This CPT code may only be used for the initial visit.) 97803 ... re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97804 ... group (2 or more individuals), each 30 minutes. Effective Oct. 1, 2002, basic coverage of MNT for the first year is three hours and basic coverage in subsequent years is two hours. If you employ appropriate staff to provide this service, and see patients with appropriate diagnoses, ask your Medicare carrier for complete coverage requirements.