Wiki E/M and 97802

Create Wiki
L

LLovett

Guest
Messages
1,719
Best answers
0
I am seeing providers code both an E/M (could be problem or well) and 97802. There are no CCI edits in place but the documentation is not supporting time for the nutritional therapy and, especially with the well care, I don't think there is enough to support billing this service in addition to the E/M.

These are going primarily to commercial payers, no Medicare.

Just looking for others thoughts or supporting information.

Thanks

Laura, CPC, CPMA, CEMC
 
Medicaid will allow four (4) visits per calendar year. Services must be provided by a licensed registered dietitian (LRD) or nutrition professional meeting certain requirements.

do these physicians meet the above as it is for dietitians not pcp's etc
 
These are just physician, no special additional training. They are getting paid for these visits though. Which of course is their argument...
 
CPT 97802–97804. "These codes should be reported only for services provided by nutritionists. If a physician provides medical nutrition therapy, the E/M or preventive services codes should be used. Private payers may also accept HCPCS codes S9452, S9465 or S9470 for a session of nutrition therapy provided by a nutritionist."

http://www.aafp.org/fpm/2006/1000/p29.html
 
Can you bill them together

Does anyone know if you can bill 97802 or 97803 with S9470?
I have billed them together, Some ins companies pay for both codes and some do not. What is the rule, or is it up to the ins co.
 
dkbill said:
Does anyone know if you can bill 97802 or 97803 with S9470?
I have billed them together, Some ins companies pay for both codes and some do not. What is the rule, or is it up to the ins co.
Click to expand...

Unless the payer specifically requests S codes use CPT codes instead. As far as I can tell billing the CPT & the S code is double billing
 
CodingKing said:
Unless the payer specifically requests S codes use CPT codes instead. As far as I can tell billing the CPT & the S code is double billing
Click to expand...
Question? If you billing S9470 with 59 modifier since it is listed under supplies and services would that be allowed?
 
You must log in or register to reply here.
Top