Pediatric Coding Alert

Since CPT Codes introduced a trio of new codes in 2001 to medical nutrition therapy (MNT), numerous specialties are reaping the benefits. Many pediatric offices are stuck in a rut, however, and could energize revenues with 97802-97804.

"Many practices completely forget about these codes, which can offer incredible benefits to obese and diabetic children," says Victoria Jackson, administrator and chief executive officer of Southern Orange County Pediatric Associates and owner and executive director of OMNI Management Inc., a medical practice management and billing company in southern California. Although pediatric practices can't take advantage of many internal medicine procedures, such as laser ablation, they should look at ways to generate non-E/M revenue. MNT is certainly one of the areas pediatricians should consider having staff offer, says Jackson, whose group is now creating an MNT program. Before you assign these codes, spend 30 minutes acquainting yourself with the MNT pyramid. Start with a healthy dose of the credentials and qualifications necessary to report these codes. Follow with what the counseling entails. Make sure you have a solid base of medically necessary patient requirements and your carriers'coverage guidelines. Who Can Use the Codes? Underusing MNT codes may stem from not understanding the credentials necessary to use 97802 (Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes), 97803 ( re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes) and 97804 ( group [2 or more individuals], each 30 minutes). Unlike certain E/M codes that require physicians to perform the services, 97802-97804 are only for non-physician use. Depending on the payer, registered nurses (RNs) and nurse practitioners (NPs) can provide initial assessment and intervention (97802) as well as reassessment and intervention (97803-97804).

"Not all plans require the counselor to be a dietitian," Jackson says. For instance, Blue Cross/Blue Shield of Massachusetts permits NPs to bill MNT codes. But other insurers may require the nonphysician practitioner to be a registered dietitian (RD) or certified nutrition professional. "An RD possesses nutrition training to address specific medical nutrition needs that may be beyond a nurse's or NP's scope," says Pat McKnight, MS, RD, LD, assistant nutrition professor for Mount Carmel College of Nursing and legislation chair for the Ohio Dietetic Association and the Ohio Nutritional Council in Columbus. So, before starting an MNT program, you should check with payers and state guidelines for credential requirements. Of course, prior to billing MNT, your pediatrician will have to meet with the patient and recommend therapy. For this "referral" visit, you should use a preventive medicine counseling code (99401-99404, Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure] ) to report [...]