Pediatric Coding Alert

Use this action plan so you won't miss out on reimbursement The number of diabetes cases continues to rise, so you can't afford to miss out on reimbursement for nutritional and educational services that your staff dieticians provide. As long as you closely adhere to five basic steps, you'll find fewer denials waiting for you.

A Michigan subscriber recently sent the following question to Pediatric Coding Alert: "We have access to medical nutrition therapy (MNT) here, as well as diabetes education, but not many diagnoses are covered. I'm wondering how pediatricians are able to collect payment for MNT that they provide to kids."

When your practice takes part in these prevention efforts by offering nutritionist- or dietician-run nutrition therapy sessions, here's how you can ensure that you collect reimbursement. Step 1: Choose Between CPT and HCPCS Codes When an individual nutritionist consults with a patient in a noncertified physician setting, you'll most likely report diabetic sessions with 97802-97804. But if your practice has an American Diabetes Association-approved program, you may also use Medicare-specific codes G0108-G0109, says Maureen Latanick, PhD, RD, CDE, a nutritionist with Millhon Medical Clinic in Columbus, Ohio.

Here's how: For noncertified programs, select the nutrition session code based on the patient's diagnosis and the number of individuals involved. Use 97802 (Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes) for initial medical nutrition therapy involving a single patient, Latanick says.

Report a follow-up patient session with CPT 97803 (... re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes), she says. For group sessions, assign 97804 (... group [2 or more individuals], each 30 minutes).

Example: After a pediatrician diagnoses a patient with diabetes and orders MNT, the practice's certified nutritionist meets with the patient for a 45-minute initial assessment and intervention. The patient later returns for a two-hour group session that involves re-assessment and intervention. You should report the initial session with three units of 97802 and the group follow-up session with four units of 97804. One unit of the individual code represents 15 minutes, and a group unit consists of 30 minutes.

To code ADA-certified diabetes self-management training (DSMT) sessions, determine how many patients attended the service. Code individual sessions with G0108 (Diabetes outpatient self-management training services, individual, per 30 minutes). When two or more patients attend the session, assign G0109 (Diabetes self-management training services, group session [2 or more], per 30 minutes).

Step 2: Report Under the Nutritionist's ID Number Prompt payment for MNT sessions depends on avoiding one common filing mistake: reporting these sessions as incident-to. Because 97802-97804 are nutritionist-specific codes, you should not report these codes incident-to a physician, says Greg Avellana, a registered dietician (RD) for an Ohio physician's office. [...]