MandyBMC

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Hello,

I work in an office with PCPs and RDs and I am looking for some guidance. We are billing MNT, ordered by our clinicians and billed by our RDs. How important do you feel that the order/referral from the PCP with DX is to the DX billed by the RD? Do you see any issue with the RD adding additional diagnoses? Do you see any issue with our RDs billing for something completely different from the DX referred for, so not including the referral DX on the claim?

Also, should non-certified coders be selecting the order of DX to get the claim paid by reordering the diagnoses?

Any help would be much appreciated!
Thanks!
 
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The treating physician must write the order, including the diagnoses to support medical necessity. If a change in treatment needs to happen, the physician is who needs to update the diagnoses to meet the criteria for the changes requested. The RD is able to choose how many units are used on a particular day, but any change in DX needs to come from the ordering provider. The RD must follow the orders, not re-write them by changing the diagnoses.

There are a fairly significant amount of rules and guidelines for MNT. I'm not sure if a non-cert coder would be the best choice if an alternative is available. If the non-cert coder is completely and thoroughly trained on those guidelines and the coding for the services, then I suppose I wouldn't eliminate that person from possibly coding. The hang-up is, because only a limited number of hours are covered and those hours differ from the first year versus the second, if the non-cert coder submits a claim incorrectly, it could really mess up the benefits for the patient, say if too many hours are billed (ultimately leading to the patient not being able to receive the actual time they are afforded).
 

MandyBMC

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Thank you for this!

If anyone else has anything additional to chime in our here, for me to share with our clinicians, I would love to hear it.
 
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Pam Brooks

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Registered dietitians who are also Certified Diabetes Educators (CDE) may bill Medicare for professional services (MNT, Diabetes Education, etc) under their own NPI. Some commercial payers also allow this. In those circumstances, the diagnosis on the order is helpful, but the RD, CDE can assign a diagnosis based on her clinical assessment. In the facility setting, or if the RD is not a CDE, we use only the diagnosis on the order.

In terms of whether or not to use a certified coder or not, it really depends on your organization's policies. Our hospital will not allow anyone other than a physician, mid-level or certified coder to append a diagnosis code on a claim. And all coders that are employed here are required to be certified. But there's no regulation or national guidance that says a coder has to be certified, so it would be important to train the person with regards to the sequencing guidelines.
 
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