Diabetic counseling for OBs - payment outside the global package?


Perryville, MO
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I've researched this quite a bit on the internet and AAPC forum. I'm hoping to find out if there is an OBGYN clinic who has been successful at receiving additional reimbursement for Diabetic counseling to an OB patient. Our OBGYN clinic would like to institute diabetic counseling to diabetic patients with the NP who is part of the OBGYN clinic. This would not be a service as part of their routine OB care, and would be scheduled specifically for counseling. I've seen options of waiting until the patient delivers and then billing an E&M if they exceed the routine 13 visits. I've also seen options for billing G0108 if 30 minutes of counseling is provided and billing that at the time of service. Another suggestion was bill and E&M with a -25 at the time of service. Anyone have success in billing one of these methods out of the OBGYN clinic?

Thank you
April Rader, CPC


Memphis, TN
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Disclaimer - I am new to OB coding, about six weeks now. However, I did work for a multispecialty practice about 6 months ago that had certified registered dietitians providing diabetic education in our certified outpatient diabetes education enter and we still struggled with payment, mostly related to credentialing. My understanding is that diabetic teaching if only billable when performed by a registered dietitian who is certified and the service is provided in a certified diabetes education center. Our Internal Medicine providers continually tried to bill the diabetes education codes and they were always adjusted. We just had to continue to educate them that not all specialties were eligible for reimbursement.

I now work for a different multi-specialty practice that has 5 maternal fetal medicine specialists who mostly are supervising high-risk pregnancies. Since diabetes is the reason for many of our referrals, we have to constantly review and counsel our patients including the risks associated with diabetes and pregnancy. Since our patients require counseling for such complicated issues, it's not uncommon for counseling time to exceed 50% of the entire visit so we bill based on time.

However, billing the specific diabetes education codes involves jumping through a lot of hoops and will require that your practiced become a certified education center and that the education be done by a certified RD.

Hope this helps.

Tammy Alton, CPC
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Diabetic care

Hello everyone,

In this scenario nurse practitioner is spent 30 minutes for diabetic care , so can we bill any CPT code for this care?

Diabetes Type 2
-A1c level reviewed and high. I recommended patient see a nutritionist as her diet is not good she refuses
stating she saw one in the past and they just told her to eat small portions of food and she will starve to death
if she goes by what they tell her. She did not start the januvia and refuses to stating she read it will cause her
to lose weight and she does not need to lose weight. I have encouraged her to see an endocrinologist and
she has not agreed to do this yet. I did discuss with her the need to keep sugar down or she will end up with
problems with eye sight and kidney function and can even possibly lose limbs if the diabetes get high enough.
30 minutes spent face to face with patient discussing diabetes care.