What should a Medical Practice know about Obesity Counselling & MNT Billing?
Obesity is an ongoing epidemic affecting adults and children. Obesity leads to various health issues. The state of affairs has been worsened with prevalence of COVID.
Providers manage obesity and related conditions through therapies and counseling. It is even more integral for an internist or a family physician who sees these kinds of cases on regular basis.
In this article, highlighting simple services to improve obese patients' health.
Where the term ‘over-weight’ or ‘obese’ is used?
Obesity and overweight have different clinical and coding implications. A patient is supposed ‘over-weight’ or ‘obese’ on the basis of their BMI (body mass Index). Higher BMI values indicate obesity, important for coders to understand. Specifically, BMI 25-30 is overweight, 35.0 is obese.
This can all be better understood by the ICD-10 codes assigned to each of the BMI ranges.
Some Guidelines:
- Use these BMI related ICD-10 codes when billing obesity counselling services.
- ICD-10 codes support medical necessity and reimbursement.
- Look for medical notes, when not sure about what billable ICD-10 to choose from.
- BMI is documented during vital signs.
- BMI can be calculated from documented weight and height.
- Use E66.09 – E66.9 for better explaining other causes of obesity in your claims.
What services can be billed for standard obesity counselling?
G0447 - Face-to-face behavioral counseling for obesity, 15 minutes
G0473 – Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes
HCPCs code G0447 is for obesity counseling. Medicare and other payers cover G0447 up to 22 times in 12 months. The valid ICD-10 codes that can be used with G0447 will start from Z68. 30 for BMI exceeding the value of 30. G0447 is a 15-minute code for primary care providers.
Frequency Limitations:
Month 0 - 1:
one visit every week;
Months 2 – 6:
one visit every other week; and
Months 7 – 12:
one visit every month if certain requirements are met
Other reporting specifications:
- Document weight loss at 6-month visit.
- 3kg weight loss needed for monthly visits.
- Reassess readiness and BMI after 6 months.
What services can be billed for Medical Nutritional Therapy (MNT) ?
MNT sessions review patient's medical condition and treatment. They perform a nutrition screening & review the specific dietary plan for the patient. The provider re-evaluates the diet in such a way that it improves the health and quality of life of the patient.
Following services can be billed for MNT:
CPT 97802 - MNT initial assessment and intervention, 15 minutes per patient.
CPT 97803 - MNT re-assessment and intervention, 15 minutes per patient.
CPT 97804 - Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes
HCPC S9470 - Nutritional counseling, dietitian visit
For Medicare Beneficiaries:
HCPCS G0270 - MNT reassessment and intervention after second referral, 15 minutes.
HCPCS G0271 - MNT group reassessment and intervention after second referral, 30 minutes.
Some Guidelines:
- MNT codes require stated time spent. A minimum of 8 minutes are needed to be spent and documented to report these services.
- These services are provided by Licensed/Registered Dietician or Nutritionist specifically. These services are never billed as ‘incident-to’ services.
- Modifier AE for Registered dietician can be appended to MNT codes. This modifier indicates the services of a nutrition professional or a registered dietician.
- MNT limited to 3 hours one-on-one in first year.
- Always use the nutritionist’s national provider identifier.
- MNT can be provided via telehealth.
- MNT follows obesity screening and referral.
- MNT codes follow a specific sequence.
- Same diagnosis rules apply.
- Services cover various medical conditions.
- Always check with third-party payer policies for reporting these services.
- In some cases, an ABN might be required.
What services can be billed for a ‘healthy’ patient?
If the patient is not necessarily obese or have their BMI under control i.e., the BMI is under <30. First, check E/M visits, then preventive coding. These are also time-based codes. Provider counsels on diet, exercise, obesity and behavior change.
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