Primary Care Coding Alert

Private-payers' rules vary from Medicare's Is your family practice providing medical nutrition therapy (MNT)? If so, you'll need to know if you should report an office visit (99212-99214), MNT (97802-97804) or preventive medicine service (99401-99404) code for nutrition counseling.
 
Depending on the payer, any of these codes may apply. Coding experts offer the following advice regarding billing MNT services. 1. Check Your Plans' Credential Requirements You should first check with payers and state guidelines regarding who can provide nutrition counseling. CPT's only rule is that nonphysicians use 97802 (Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes), 97803 (... reassessment and intervention, individual, face-to-face with the patient, each 15 minutes ) and 97804 (... group [2 or more individuals], each 30 minutes).
 
"Not all plans require the counselor to be a dietitian," says Victoria Jackson, executive director of OMNI Management Inc., a medical practice management and billing company in southern California.
 
Some insurers allow registered nurses (RNs) and nurse practitioners (NPs) to provide initial assessment and intervention (97802) as well as reassessment and intervention (97803) and group therapy (97804). For instance, Blue Cross/Blue Shield of Massachusetts permits NPs to bill MNT codes, Jackson says.
 
Medicare alert: But other insurers, such as Medicare, require that a registered dietitian (RD) or certified nutrition professional provide MNT. "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. 2. Report E/M, MNT for Same-Day Referral, Assessment Before billing MNT, your FP has to meet with the patient and recommend therapy. For this "referral" visit, you should choose the appropriate E/M code that describes the service.
 
If your FP provides anticipatory nutrition guidance, 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] ...). When a visit involves nutrition guidance for an established problem, you should report an office visit ( CPT 99201 - 99215 , Office or other outpatient visit for the E/M of a new or established patient ...).
 
If the FP identifies the need for MNT at an office visit and the nutrition counselor assesses the patient afterward, you may report both the E/M service and 97802.
 
By definition, the physician and nonphysician provide different services, Jackson says. For payers that follow the National Correct Coding Initiative, you will need to append modifier -59 (Distinct procedural service) to 97802-97804 to identify the MNT as a distinct service from the E/M.
 
3. Know What Diagnoses Your Payers Accept [...]