Fruita, CO
Best answers
OK, here's the deal:

I have a physician and a Registered Dietitian who wish to hold group nutrition and/or diabetes counseling sessions. Let's assume the session is 30 minutes long and involves 10 patients. This is their scenario:
  1. The physician wishes to charge each patient with an E/M encounter by total time. E/Ms pay more than physician group therapy codes and E/Ms pay more than Dietitian Medical Nutrition Therapy codes.
  2. Assuming that the physician provides half of the counseling, and the Registered Dietitian provides the other half of the counseling, the physician wants to add their times together (combined total = 30 minutes) to level the E/M's by total time.
  3. The physician wishes to charge each of the 10 participants an E/M 99214 based on 30 minutes of total time.
The document the physician found that began them developing this program is here:

I received much pushback when I advised that their assumptions were incorrect and that what they have proposed is a very bad idea from a coding perspective.

Please provide advice on each of the points above. Feel free to quote authoritative sources.

Thank you for your help. You know how it is, nobody believes a prophet in their hometown.

1. The article clearly states that providers should contact their payers about group billing for E/M visits and that additional services such as MNT should be coded separately. I'm not sure how they're confused on that score. However, if they need more convincing point them to Instructions for Use of the CPT Codebook at the front of the CPT manual. The code reported has to be the one that most accurately describes the one performed.
2. This is a scope of practice issue. A registered dietician can't perform or report E/M visits, so their time can't be counted toward the code.
3. I think this is addressed in 1 and 2. Good luck. :)
Hi Firetorah
I d let the doctor or NP or PA do his Eval/Mg CPT and time on medical dx of the patient , then when he is finished the patient could go to next room with dietician. Or dietician come in for next 15 to 30 minutes give nutrition counseling or sit with the dietician and bill on the claim CPT 99401 to 99404 or 97801 to 97084. Add modifier 25 to doctors Eval Mgmt CPT , put on same claim list both providers names. Also minute must be put in the dietician's medical record note on amount of time talk to pt. about obesity or DM food and diet management. Add the Obesity/Nutrition's dx code E66, F50, R63.5, dx Z68 with BMI%, Z13.21 or Z13.22 and Z71.2 or Z72.4 and diet recommendations Etc. This must be a separate pt. visit not group treatment and not under docs eval/mgnt code.

Has your office thought about doing telemedicine or phone calls on nutrition visits for elderly folks or busy pts? The dieticians can use CPT 98966 to 98972 phone calls. Document top of med record verify correct pt, pt. gave permission for phone call or using online Zoom devices or phone calls in the med record for the day. Documentation still required with time of call, discussion items and proper dx codes by dietician. Add referring doc on claim the MD who suggested dietician assistance for this pt. Use modifier 95 for any treatment online with the video or Zoom. Also clear with your payer first see if permissible they may want treatment plan or preautho call first.
Did any of this help you? I hope so :)
Good luck!
Lady T