Medical nutrition therapy (MNT) is a key component of diabetes education and management. MNT is defined as a ‘nutrition-based treatment provided by a registered dietitian nutritionist.’ It includes ‘a nutrition diagnosis as well as therapeutic and counseling services to help manage diabetes.’ MNT Is an intensive, focused, and comprehensive nutrition therapy service which involves in-depth individualized nutrition assessment.
It relies heavily on the follow-up to provide repeated reinforcement to aid with behavior change. MNT plans for follow-up over multiple visits to assist with behavioral and lifestyle changes relative to each individual’s nutrition problems and medical condition or diseases.
Navigating insurance billing in your nutrition private practice can be confusing. Evolving legislation and coverage for telehealth services only further complicates the matter. Whether you are in-network with insurance companies or create superbills for your clients, it is beneficial to be well-acquainted with insurance billing codes.
This will allow you to save time when creating CMS-1500 claims or Superbills and decrease the risk of claim denial. We’ve compiled a list of insurance billing codes that every dietitian should know, including ICD-10 codes, CPT codes, and G codes. Use this guide as a starting point for learning the billing process.
ICD-10 Diagnosis Codes
ICD stands for “International Classification of Diseases.“ These codes are used by physicians and medical coders to assign medical diagnoses to individual patients. Registered dietitians cannot make medical diagnoses. However, these codes are used on CMS 1500 forms, referrals, and superbills. Common ICD-10 diagnosis codes you will see on referrals are:
- Z71.3: Dietary counseling and surveillance (typically used for preventative services)
- E11. __: Type 2 Diabetes (the ___ specifies if any complications are present)
- E66.0: Obese due to excess calories
- E66.3: Overweight (weight management referrals)
CPT, or Current Procedural Terminology, codes are the codes that identify the service you provided as a healthcare professional. The three most common medical nutrition therapy (MNT) codes that dietitians use on claims are listed below. Public insurers, like Medicare and Medicaid, as well as private insurance carriers, can use these CPT codes.
- 97802 – For an initial assessment, face-to-face
- 97803 – For a follow-up visit or reassessment, face-to-face
- 97804 – For a group visit (2 or more individuals)
When creating a superbill or filling out a CMS 1500 form, you will also have to specify the number of units and your fee per unit. Keep in mind, insurance billing is in units of 15 minutes each. This means a 1-hour initial assessment is 4 units.
Then, when filing a claim, it is necessary to add a modifier to the end of the CPT code for video counseling services. The two most commonly used modifiers are:
- GQ – Asynchronous Telecommunications systems, such as a pre-recorded video
- GT – Interactive Audio and Video Telecommunications systems, including a live video conferencing session
More recently, the billing codes for telehealth have been changing. Modifier codes are being replaced by using the place of service: 02 telehealth
Tip: Many insurance companies are rapidly changing their coverage for telecommunications, so always perform an eligibility check before providing your services.
Most insurance companies limit the number of sessions covered per the calendar year. If a client exhausts their benefits, and their referring physician determines a change in diagnosis that requires your service, you will use G codes to bill for the rest of the year. The most common G codes are:
- G0270 – 15-minute one-on-one session for a reassessment due to a new or change in diagnosis
- G0271 – 30-minute group session for a reassessment due to a new or change in diagnosis
To reduce denials, ask in-network insurance companies for the latest updates and preferences. Insurance billing varies from company to company and, state to state. The above article is a glimpse of the frequently-used codes. For more accurate DSMT and MNT coding and billing you can contact us at 888–firstname.lastname@example.org