What should a Medical Practice know about Obesity Counselling & MNT Billing?
Obesity is often labelled as an on-going epidemic, which has not only affected adults but growing children as well. Rising cases of obesity consequentially give birth to all sorts of detrimental diseases and conditions ranging from depression to diabetes and cardiovascular issues. The state of affairs has been worsened with prevalence of COVID.
Needless to say, a healthcare provider tries best to take notice and manage the current and associated conditions of their obese patients by different routes of therapies and counselling sessions. It is even more integral for an internist or a family physician who sees these kinds of cases on regular basis.
In this article we try to give spot-light to these seemingly simple services that can improve the overall health of the obese and over-weight patients; which a coder should be aware of and a healthcare provider shouldn’t miss.
Where the term ‘over-weight’ or ‘obese’ is used?
Even if these terms feel similar, they are considered quite different clinically and from a coding perspective. A patient is supposed ‘over-weight’ or ‘obese’ on the basis of their BMI (Body mass Index). We won’t go into its mathematics and calculations but as a coder you should at least know higher BMI values leans more towards obesity. Specifically, a patient with BMI above 25 and under 30 is deemed as over-weight and a patient with a BMI of 35.0 would be considered obese.
This can all be better understood by the ICD-10 codes assigned to each of the BMI ranges.
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 used for Intensive Behavioral Therapy (IBT) for Obesity or ongoing face-to-face behavioral counseling for patients with a BMI of ≥ 30, who are alert and able to participate in counseling. Medicare and following payers pay for G0447 which can be billed 22 times in a 12-month period counted from the date of the first claim. 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 timed code for 15 minutes furnished by a qualified primary care physician or other primary care practitioner in a primary care setting.
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:
What services can be billed for Medical Nutritional Therapy (MNT) ?
During MNT sessions a dietitian (or qualified nutrition professional) reviews the changes in the medical condition of the patient, including their diagnosis and treatment regimen. They perform a nutrition screening and 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 - Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
CPT 97803 - Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
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 - Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes
HCPCS G0271 - Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes
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 look to E/M or office visits that might include counselling then look into preventive coding for separate counselling sessions that the patient might need for instance 99401-99404 can be used in such cases. These are also time-based codes. The provider will likely counsel the patient on diet, exercise, and obesity and provide behavior change interventions, including assessing readiness and barriers to change, advising a change, or actions and motivational counseling.
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