New Rules Beckon Proper Use of Medical Nutrition Codes
Published on Fri Mar 01, 2002
Family physicians have a new option for providing nutrition counseling to Medicare patients with diabetes or renal disease. Medicare rules were recently finalized for medical nutrition therapy (MNT) codes 97802-97804, which provide payment for outpatient counseling by registered dietitians or nutritionists in an individual or group setting.
The codes, covered by Medicare effective Jan. 1, 2002, are:
97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with patient, each 15 minutes
97803 re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97804 group (2 or more individual[s]), each 30 minutes.
Code 97802 should be used for the initial patient visit for an individual MNT and represents 15-minute increments. For follow-up individual visits, use 97803, again in 15-minute increments. Code 97804 is for group counseling, both initial and follow-up, provided in 30-minute increments.
Physician offices should know key facts about Medicare's rules for MNT codes:
The MNT codes can be used only for MNT provided by registered dietitians or nutrition professionals. Payment for these services goes to the registered dietitian or nutrition professional. "The physicians should be clear that these codes are not meant for them," says Emily Hill, PA-C, president of Hill & Associates, a consulting firm in Wilmington, N.C., that works with physician practices on coding and compliance.
The treating physician must refer the patient to the registered dietitian or nutrition professional for MNT.
Only two categories of Medicare patients diabetics and renal patients who have chronic renal insufficiency or who have received a kidney transplant within the past 36 months are eligible for MNT coverage. Patients with end-stage renal disease who are on dialysis are excluded.
MNT Allowed in Any Outpatient Setting
Medicare will pay for MNT provided in virtually any outpatient setting, including the physician's office, an independent dietitian's practice or a hospital outpatient department. It will not pay when the services are provided to a patient during an inpatient stay at a hospital or skilled nursing facility because fees to these facilities already include MNT.
In physicians' offices that have a registered dietitian on staff, the dietitian cannot bill the MNT codes "incident to" the physician.
"The dietitians or nutritionists must have their own Medicare provider numbers," notes Catherine Trinidad, CPC, coder for Community Health Center Network, a network of seven community health centers in Alameda County, Calif.
The registered dietitian or nutritionist must enroll as a provider in Medicare, accept assignment and contact the local Medicare carrier to complete a Form HCFA-855 before billing for MNT services. The new specialty code for registered dietitians and nutrition professionals is "71."
Most family physician offices will refer patients to registered dietitians or nutritionists for therapy, so they will not use the codes in-house. However, Pam Michael, MBA, RD, LD, [...]
