Primary Care Coding Alert

Medicare recently issued its national coverage decision on medical nutrition therapy (MNT) codes, giving family physicians the information they need to properly use the codes to refer diabetic and renal patients for counseling. The codes are:

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 97804 group (2 or more individual[s]), each 30 minutes. Medicare had already released some rules for use of the MNT codes, specifying that only patients with diabetes and patients who have chronic renal insufficiency or have received a kidney transplant within the past 36 months are eligible for MNT coverage, and that a physician must refer the patient for MNT. Only registered dietitians and nutritionists who meet certain criteria may use the MNT codes. Note: See page 19 of the March 2002 Family Practice Coding Alert for more details. In its February national coverage decision memo, Medicare spelled out the number of hours of MNT covered and provided additional information on proper use of the codes:
Medicare will pay for three hours of MNT initially on diagnosis, then two hours of follow-up MNT in subsequent years. A diabetic patient can receive diabetes self-management training (DSMT) and MNT during the same period of time (although sessions cannot be held on the same day). In making this determination, Medicare noted that nutritional counseling is only one of numerous components covered in the 10 hours of DSMT allowed upon diagnosis. Cindy Moore, MS, RD, a spokesperson for the American Dietetic Association, an organization that represents dietitians nationwide and was heavily involved in creating the MNT codes, notes that the nutritional counseling provided in DSMT is often group-based, while the emphasis in MNT is on developing an individual plan based on each patient's eating habits and therapy needs. Medicare does not prescribe a length for each MNT session, but instead suggests guidelines and leaves the final decision up to the physician and the registered dietitian or nutritionist. The guidelines suggested are a 60-minute visit for the initial assessment, followed by four 30-minute follow-up visits during the first year. For subsequent years, guidelines suggest quarterly visits of 30 minutes each. The physician may order additional hours if a change occurs in the patient's medical condition, diagnosis or treatment regimen that requires an adjustment in MNT.

Examples of changes that qualify for additional MNT include a diabetic patient who moves from oral medication to insulin, a patient with gestational diabetes who requires frequent dietary modification, or a patient with diabetes who has a diabetic complication that requires tighter dietary control. For example, patients may qualify for additional MNT if their [...]