Wiki Weight management group classes

[mmallick]

Our physicians and nurse practitioner are considering offering a weight management series for patients. This would be a weekly group meeting (similar to Weight Watchers) and would be led either by a physician or a nurse practitioner. Is this something that could be billed to insurance using CPT code 97804 or 99078? Thanks for any guidance you can give me.

 

[TThivierge]

Weight management

Hi
Ensure correct dx is first listed on claim or Z71 and the vitals of patient on each record including the BMI listed. Of course if Pt has other problems list these to per doc note. When bill on claim add the 2 BMI dx codes to coordinate together Z68 and E66 blocks on same claim. If patient has under 30 %BMI most insurers will not pay. Also most insurers will not cover more than 6 visits a year ?so check with insurance payer regs.
The CPT used is G code for only the Medicare payer and a 99xxx diet counseling /behaviors modification for commercial payers, fee range $51 to 55 .
Hope this helps you save time and less denials
T. Thivierge

 

[TThivierge]

Weight Management More Info

Hi Again!
Ensure use proper CPT codes with correct provider.
Physicians & NP can use evaluation / mgmt codes for the visit if Pt suffers for other health problems as DM, HTN etc. When this happens use the evaluation mgt code plus modifier 25 and next line on claim use diet modification codes of 99401 to 99404 per time treated with commercial insurance.
Dietitian can use CPT 97802 series
Use G codes G0447 cpt if patient has Medicare coverage
Usually insurance not cover more than 10 people jn group setting , ensure each pt there has a notation in record
Also if provider suggest exercise in notations can use new dx Z72,3 also.
I hope this has been helpful!!!
T. Thivierge