question

-Billing for nutr. services only done in outpatient -inpatient care NOT billed directly to insurance, considered part of patient's hospital visit

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Billing

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International Classification of Disease, 10th ed. implemented in practice (diagnosis codes)

answer

ICD-10 Codes

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an individual's disease or medical condition; physicians & trained billers determine these codes

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What do the ICD-10 Codes describe?

question

C.E.A.S.E.

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ICD-10 Structure

question

Category; characters 1-3

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C

question

Etiology; characters 4-6

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E

question

anatomic site; characters 4-6

answer

A

question

severity or other clinical detail; characters 4-6

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S

question

Extension; character 7 -initial or subsequent encounter -laterality (left or right) -other clinical detail (i.e. # weeks gestation)

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E (last)

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1st three numbers- disease code- not billable when more characters exist

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Category

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VERY. Category= first three characters= family code/general disease code

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How specific should you be?

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NOT BILLABLE if you include the first three characters when codes exist with GREATER SPECIFICITY (more characters)

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When is a code NOT billable?

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Claim will be rejected- not enough info. (i.e. E10= Type I DM, E11= Type II DM)

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What happens if you include the first three characters when codes exist with greater specificity?

question

NOT BILLABLE- need greater specificity -E11.4= Type II DM w/ neurological complications- this IS billable

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Is E11 Type II DM billable?

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Type II DM w/ diabetic neuropathy, unspecified

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E11.40

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Type II DM w/ diabetic mono-neuropathy

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E11.41

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Type II DM w/ diabetic poly-neuropathy

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E11.42

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Type II DM w/ other neurological complication

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E11. 49

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Type I DM w/ skin complications

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E10. 62

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Type I DM w/ diabetic dermatitis

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E10.620

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Type I DM w/ foot ulcer

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E10.621

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Type I DM w/ other skin ulcer

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E10.622

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Type I DM w/ other skin complications w/ other specified complication

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E10.628

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Codes 024.1= pre-existing DM, Type II, in pregnancy, childbirth, and the puerperium, insulin-resistant DM in pregnancy, childbirth, and the puerperium

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ICD-10 Diabetes and Pregnancy Codes 024.1

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Codes 024.11= pre-existing T2, in pregnancy

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ICD-10 Diabetes and Pregnancy Codes 024.11

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pre-existing DM, T2, in pregnancy, first trimester

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024.111

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pre-existing DM, T2, in pregnancy, second trimester

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024.112

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pre-existing DM, T2, in pregnancy, third trimester

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024.113

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pre-existing DM, T2, in pregnancy, unspecified trimester

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024.119

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pre-existing DM, T2, in childbirth

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024.12

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pre-existing DM, T2, in the puerperium

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024.13

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-Current procedural technology -Describe service performed by healthcare professional

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CPT Codes

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-Healthcare Common Procedure Coding System -Developed by payers to describe services where no CPT code exists

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HCPCS

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form that serves as a receipt provided by the healthcare provider to the patient showing fee paid, date, services, etc.

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Superbill

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MNT, initial assessment and intervention, individual, face-to-face, each 15 minutes

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CPT Codes for MNT: 97802

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MNT, reassessment and intervention, individual, face-to-face, each 15 minutes

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CPT Codes for MNT: 97803

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MNT, group, 2 or more individuals, each 30 minutes

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CPT Codes for MNT: 97804

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-Additional codes used once calendar year coverage is met -These codes allow for unlimited follow-up reassessment counseling for change in diagnosis, medical condition or treatment regimen

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MNT HCPCS "G" Codes

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MNT reassessment & subsequent interventions following 2nd referral in calendar year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), individual, face-to-face, 15 minutes each

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MNT HCPCS "G" Codes: G0270

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MNT reassessment & subsequent intervention...group, 2 or more individuals, face-to-face, each 30 minutes

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MNT HCPCS "G" Codes: G0271

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-Prevention codes are designed for preventative nutrition counseling and/or risk factor reduction intervention

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HCPCS or "S" Codes

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Nutr. counseling dietitian visit

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HCPCS or "S" Codes: S9470

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Diabetic management program dietitian visit

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HCPCS or "S" Codes: S9465

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Nutrition classes non-physician provider, per session

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HCPCS or "S" Codes: S9452

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Weight management classes non-physician provider, per session

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HCPCS or "S" Codes: S9449

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-Medicare covers obesity counseling when BMI is over 30 -Rules are very strict -Must be completed in a doctor's office or outpatient clinic only! -RDN must bill under doctor's or hospital's NPI, not their own. -Individual assessment limited to 15 minutes/day -Group assessment limited to 30 minutes/day

answer

Medicare obesity coverage

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-Education and training codes -Medical team conference codes -Telephone services -Online medical evaluations

answer

Other codes for non-Medicare MNT services include...

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standard, unique identifier that is used on healthcare claims

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NPI: National Provider Identifier

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-Obtain an NPI number -Consider CAQH

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How to become a credentialed provider w/ a payer-

question

Council for Affordable Quality Healthcare -Nonprofit health alliance of health plans and other groups that has developed a single, national process and application form to eliminate the need for multiple credentialing applications with health care plans

answer

CAQH

question

1. Contact reimbursement reps w/in state dietetic association to inquire about local payers that cover MNT ; nutrition services 2. Call provider relations dept. for local payers to determine coverage ; payment for RD MNT services 3. Are they accepting additional RD providers at this time? 4. Complete credentialing paperwork 5. Review the contract details, reimbursement rates, payment time frames, allowed procedure codes, covered services/limitations 6. Know the claim processing rules 7. Verify allowed codes and diagnoses 8. Check payer policy (is preauthorization required? is a referral required?)

answer

How to become a credentialed provider w/ a payer- steps to be taken

question

-Pay a certain percentage above Medicare Part B fee schedule OR -Determine your own fee schedule rates (?) Market research to determine "going rate."

answer

How are reimbursement rates decided?

question

International Classification of Disease, 10th ed. (diagnosis codes) -describe an individual's disease or medical condition; physicians & trained billers determine these codes

answer

**What is ICD-10?

question

Category (characters 1-3), Etiology (characters 4-6), Anatomic site (characters 4-6), Severity or other clinical detail (characters 4-6), Extension (character 7)

answer

**What is CEASE?

question

Prevention codes designed for preventative nutrition counseling/and/or risk factor reduction intervention

answer

**What are S Codes and when are they used?

question

National Provider Identifier- standard, unique identifier that is used on healthcare claims

answer

**What is NPI?

question

1-2-3-4-5-6-7 Category- 1st three numbers-disease code-not billable when more characters exist --> Etiology --> Extension

answer

**ICD-10 Structure

Medical Nutrition Therapy: Reimbursement/Coding & Billing – Flashcards

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