Please Help- Nurse Prac

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I work at a new clinic that specializes in Diabetes.
Lately we have had several physicians refer their patients to us for DM education only and so they get scheduled with one of our nurse practitioners.
How would I bill this?
I have been using cpt codes 97802 and 97803 but they are getting denied because the NP is not a registered dietician.
Are there any other codes out there aside from the E/M codes 99211-99215?
 

thomas7331

True Blue
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For Medicare, diabetes education (also called diabetes self management training or DSMT) is billed with HCPCS codes G0108 and G0109, but the regulations and coverage requirements surrounding this are unfortunately a bit complex and Medicare has done targeted audits of these services so it's important to get it right. Other payers may require different codes. There is detailed info on coverage and billing in chapter 15 of the Medicare Benefit Policy Manual, link below - see section 300 starting on page 265: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf

If you're going to offer this, you will probably want to have your clinic accredited as a diabetes education program through either the AADE or ADA; both organizations will also offer guidance on billing and reimbursement - here are their web sites which have a lot of good information about this and I think will answer many of your questions:

https://www.diabeteseducator.org/pr...ion-program-(deap)/applying-for-accreditation

http://professional.diabetes.org/diabetes-education

In my experience this can be a challenging area for coding and billing. Hope this will help some.
 
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