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Cra
ckin
g th
e C
ode
Alp
habe
t So
up:
Und
erst
andi
ng t
he
Use
of
Cod
ing/
Bill
ing
Term
inol
ogy
Jane
V. W
hite
, PhD
, RD
, LD
N, F
AND
Em
eritu
s Pr
ofes
sor,
Fam
ily M
edic
ine
Uni
vers
ity o
f Te
nnes
see
– Kn
oxvi
lle
Chai
r, Ac
adem
y Co
ding
Sur
vey
Met
hodo
logy
Tas
k Fo
rce
Aca
dem
y Re
pres
enta
tive:
AM
A RU
C H
CPAC
Sand
i Mor
ris, R
D,C
D
Indi
ana
Uni
vers
ity H
ealth
-Gos
hen
Hos
pita
l Cl
inic
al N
utrit
ion
Man
ager
IA
ND
Rei
mbu
rsem
ent
Repr
esen
tativ
e
2
Dis
clos
ures
We
have
no
com
mer
cial
rel
atio
nshi
ps t
o di
sclo
se r
elev
ant
to t
he t
opic
bei
ng
pres
ente
d.
Sess
ion
Obj
ectiv
es
•Id
entif
y pr
oced
ure
code
s fo
r nu
triti
on a
nd n
utrit
ion-
rela
ted
serv
ices
tha
t m
ay b
e re
imbu
rsed
by
Med
icar
e an
d/or
com
mer
cial
thi
rd p
arty
pay
ers.
•
Und
erst
and
the
term
s fo
und
on a
typ
ical
cla
ims
form
an
d th
e pr
oper
pro
cedu
re fo
r su
bmitt
ing
a “c
lean
” cl
aim
.
•Re
cogn
ize
oppo
rtun
ities
to
expa
nd n
utrit
ion
prac
tice
to
rece
ive
paym
ent
for
nutr
ition
and
nut
ritio
n-re
late
d se
rvic
es in
mul
tiple
set
tings
.
•Re
cogn
ize
new
too
ls a
nd r
esou
rces
incl
uded
on
the
Acad
emy’
s w
ebsi
te t
o he
lp e
duca
te R
DN
s on
thi
s to
pic.
•Re
cogn
ize
codi
ng u
se a
nd p
aym
ent
tren
ds a
mon
g RD
Ns
acro
ss t
he c
ount
ry.
4
Beck
y Su
lik, R
D, C
DE,
LD
- C
hair
Luci
lle B
esel
er, M
S, R
D, C
DE,
LD
N -
Vic
e-Ch
air
Amy
Dav
is, R
D, L
RD
Den
ice
Ferk
o-Ad
ams,
MPH
, RD
N, L
DN
Lo
rri H
olzb
erg,
MA,
RD
N
Ingr
id K
nigh
t, R
D
Alex
is P
ezzu
llo, M
PH, R
D, L
DN
Ex
-Offi
cio:
•
Keith
Ayo
ob, E
dD, R
D, C
D/N
, FAD
A (C
PT P
anel
Rep
) •
Jane
Whi
te, P
hD, R
D, L
DN
, FAN
D (
RUC
Pane
l Rep
) St
aff:
•
Mar
sha
Scho
field
, MS,
RD
, LD
N, F
AND
•
Mar
a Bu
jnow
ski,
MAE
d, R
D, L
D
Acad
emy
Nut
ritio
n Se
rvic
es P
aym
ent
Com
mitt
ee (
NSP
C)
NSP
C Pu
rpos
e/M
embe
r Be
nefit
s
Mem
ber E
duca
tion
Deve
lop,
impl
emen
t and
mar
ket
a m
ulti-
face
ted
mem
ber
educ
atio
n pl
an th
at a
ddre
sses
va
rious
pra
ctic
e se
ttin
gs, l
evel
s of
mem
ber e
xper
tise
and
curr
ent a
nd fu
ture
pay
men
t m
odel
s..
Advo
cacy
In
crea
se R
DN re
cogn
ition
and
co
vera
ge fo
r RDN
serv
ices
.
Cod
e Cr
eatio
n/Va
luat
ion
Deve
lop
prop
osal
s to
deci
sion
mak
ers t
hat e
xpan
d th
e ra
nge
of
serv
ices
that
can
be re
imbu
rsed
an
d re
port
ed b
y RD
Ns.
Colla
bora
tion
or In
fluen
ce
Advi
se a
nd c
olla
bora
te w
ith
Acad
emy
orga
niza
tiona
l uni
ts to
ac
hiev
e Co
mm
ittee
's go
als.
Nat
iona
l/Gra
ssro
ots
Publ
ic P
ayer
s/Pr
ivat
e Pa
yers
Intr
oduc
tory
Ter
ms
& A
cron
yms
AM
A:
Amer
ican
Med
ical
Ass
ocia
tion
CP
T: C
urre
nt P
roce
dura
l Ter
min
olog
y Pa
nel
•Co
de C
reat
ion
Pane
l � �
� S
ervi
ces
Des
crip
tors
R
UC
: RV
S U
pdat
e Co
mm
ittee
•
Code
Val
uatio
n Pa
nel �
� �
Pay
men
t R
VS:
Res
ourc
e-Ba
sed
Rela
tive
Valu
e Sy
stem
H
CP
AC
: H
ealth
Car
e Pr
ofes
sion
als
Advi
sory
Co
mm
ittee
(no
n-ph
ysic
ian
pane
l) N
CP
T: A
cade
my
deve
lope
d st
anda
rdiz
ed la
ngua
ge u
sed
to d
escr
ibe
the
Nut
ritio
n Ca
re P
roce
ss;
used
in t
he
docu
men
tatio
n of
nut
ritio
n se
rvic
es p
rovi
sion
•
does
not
rep
lace
ICD
-9 d
iagn
osis
Basi
c Te
rms
and
Acro
nym
s
CM
S: C
ente
rs fo
r M
edic
are
& M
edic
aid
Serv
ices
M
edic
are
• P
art
A:
Hos
pita
l ser
vice
s •
Par
t B
: O
utpa
tient
pro
fess
iona
l ser
vice
s (M
NT)
, D
iagn
ostic
tes
ts/L
ab, e
tc.
• Par
t C
: M
C Ad
vant
age
Plan
s • P
art
D:
Pres
crip
tion
drug
s H
IPA
A:
Hea
lth I
nsur
ance
Por
tabi
lity
& A
ccou
ntab
ility
Act
N
PI:
Nat
iona
l Pro
vide
r Id
entif
ier
Cre
dent
ialin
g: a
sys
tem
atic
app
roac
h to
the
col
lect
ion
and
verif
icat
ion
of p
rofe
ssio
nal q
ualif
icat
ions
Nat
iona
l Pro
vide
r Id
entif
ier
(NPI
)
•A
10-d
igit
num
ber
used
to
reco
gniz
e th
e pr
ovid
er o
n cl
aim
s tr
ansa
ctio
ns.
•
All p
rovi
ders
who
bill
3rd p
arty
pay
ers
mus
t ha
ve o
ne (
HIP
AA r
equi
rem
ent)
•La
sts
inde
finite
ly;
does
NO
T co
ntai
n “i
ntel
ligen
ce”
•
Each
pro
vide
r ge
ts O
NE
NPI
, reg
ardl
ess
of t
he n
umbe
r of
pra
ctic
e of
fices
.
•G
roup
pra
ctic
es, h
ospi
tals
, and
cor
pora
tions
get
an
NPI
(se
e CM
S M
edle
arn
artic
le:
http
://w
ww
.cm
s.hh
s.go
v/M
edic
areP
rovi
derS
upEn
roll/
dow
nloa
ds/E
nrol
lmen
tShe
et_W
WW
WH
•Co
ntac
t th
e N
atio
nal P
lan
& P
rovi
der
Enum
erat
ion
Syst
em N
OW
! •
Appl
y ov
er t
he W
eb:
http
s://
nppe
s.cm
s.hh
s.go
v/N
PPES
/Wel
com
e.do
•
Appl
y by
pho
ne:
1-80
0-46
5-32
03 (
NPI
Tol
l-Fre
e)
Beco
me
a Q
ualif
ied
Prov
ider
Med
icar
e (f
ew w
eeks
) •
Com
plet
e pr
oces
s on
line:
ht
tp:/
/ww
w.c
ms.
gov/
Med
icar
e/Pr
ovid
er-E
nrol
lmen
t-an
d-Ce
rtifi
catio
n/M
edic
areP
rovi
derS
upEn
roll/
inde
x.ht
ml
Pr
ivat
e pa
yers
(6-
8 m
onth
s)
•As
k fo
r pr
ovid
er r
elat
ions
or
the
cred
entia
ling
depa
rtm
ent.
•
Requ
est
a cr
eden
tialin
g (e
nrol
lmen
t) p
acke
t fo
r RD
s.
•Ev
alua
te a
ltern
ativ
es.
•Co
nsid
er C
AQH
enr
ollm
ent
(Cou
ncil
for
Affo
rdab
le Q
ualit
y H
ealth
care
);
http
://w
ww
.caq
h.or
g/uc
d.ph
p
Med
icar
e M
NT
Mor
e Ba
sic
Term
s an
d Ac
rony
ms
Cod
es:
inte
rnat
iona
l/nat
iona
l num
eric
des
igna
tions
use
d to
des
crib
e:
•D
iagn
osis
cod
es (
ICD
-9)
= D
escr
ibe
an in
divi
dual
's d
isea
se o
r m
edic
al c
ondi
tion;
phy
sici
ans
and
trai
ned
bille
rs d
eter
min
e th
ese
code
s •
CP
T co
des
= C
urre
nt P
roce
dura
l Ter
min
olog
y co
des
(pro
cedu
re
code
s) t
hat
desc
ribe
the
serv
ice
perf
orm
ed/p
rovi
ded
to t
he p
atie
nt
by t
he h
ealth
care
pro
fess
iona
l •
HC
PC
S co
des
= H
ealth
care
Com
mon
Pro
cedu
re C
odin
g Sy
stem
de
velo
ped
by p
ayer
s (C
MS)
to
desc
ribe
serv
ices
whe
re n
o CP
T co
de e
xist
s •
PQ
RS
code
s =
Phy
sici
an Q
ualit
y Re
port
ing
Syst
em;
“vol
unta
ry”
qual
ity-r
epor
ting
syst
em/c
odes
; pe
nalti
es in
curr
ed fo
r no
n-pa
rtic
ipat
ion
or n
ot m
eetin
g re
port
ing
requ
irem
ents
ICD
-9 D
iagn
osis
Cod
es
(det
erm
ined
by
MD
) C
hron
ic K
idne
y D
isea
se (
CK
D)
- 58
5.X
in
clud
e a
4th
digi
t w
hich
des
crib
es t
he s
tage
of
kidn
ey d
isea
se
•585
.4;
chro
nic
kidn
ey d
isea
se, S
tage
IV
(sev
ere)
D
iabe
tes
Mel
litus
– 2
50.X
X
incl
ude
a 4t
h di
git
whi
ch in
dica
tes
the
type
of c
ompl
icat
ion,
and
in
clud
e a
5th
digi
t w
hich
indi
cate
s th
e di
abet
es t
ype
and
cont
rol
• 25
0.00
- t
ype
II o
r un
spec
ified
typ
e, w
ithou
t m
entio
n of
co
mpl
icat
ion,
not
sta
ted
as u
ncon
trol
led
•
250.
52 -
typ
e II
or
unsp
ecifi
ed t
ype,
with
oph
thal
mic
m
anife
stat
ions
, unc
ontr
olle
d
13
Com
ing
10/1
5: I
CD
-10C
M &
IC
D-1
0-P
CS
14
Tran
sitio
n to
ICD
-10
will
impa
ct a
ll bi
lling
so
ftw
are,
form
s, a
nd b
illin
g pr
oced
ures
Code
s ar
e al
pha-
num
eric
, up
to s
even
cha
ract
ers.
Fo
r ex
ampl
e:
d
iabe
tes,
typ
e 2.
.. W
ith c
ompl
icat
ion
E11.
8
chr
onic
kid
ney
dise
ase,
sta
ge I
II
N18
.3
Incl
udes
abo
ut 8
,000
cat
egor
ies
M
ore
at:
ww
w.e
atrig
htpr
o.or
g/re
sour
ces/
prac
tice/
gett
ing-
paid
15
Dia
gnos
is C
ode
Reso
urce
s
Com
pone
nts
of C
PT C
ode
Valu
es
3 co
mpo
nent
s ar
e re
view
ed t
o es
tabl
ish
a co
de v
alue
:
1)W
ork
- de
scri
bes
the
serv
ice
prov
ided
(48
.3%
)
•Pre
-ser
vice
w
ork
•
Revi
ew (
med
ical
) re
cord
s, la
b w
ork,
obt
ain
vita
ls, r
oom
set
up,
in
form
ed c
onse
nt, e
tc.
•I
ntra
-ser
vice
wor
k
•H
isto
ry a
nd p
rese
ntin
g pr
oble
m, r
evie
w o
f sy
stem
s, t
reat
men
t op
tions
, cre
ate
&/o
r di
strib
ute
educ
atio
nal m
ater
ials
, arr
ange
follo
w-
up a
nd/o
r re
ferr
al a
s ne
eded
•Pos
t –s
ervi
ce w
ork
•
Doc
umen
tatio
n, c
omm
unic
atio
n w
ith r
efer
ring
phys
icia
n, c
are
coor
dina
tion,
sho
rt-t
erm
(7d
) co
mm
unic
atio
n w
ith p
atie
nt a
s ne
eded
16
Def
initi
on o
f W
ork
17
•Tim
e leng
th o
f ser
vice
•M
enta
l Eff
ort/
Judg
men
t s
ynth
esis
of
data
/com
plex
ity o
f dec
isio
n m
akin
g •T
echn
ical
Ski
ll
know
ledg
e/sk
ills
set,
exp
erie
nce
•Phy
sica
l Eff
ort
ph
ysic
al n
atur
e of
wor
k in
volv
ed
•Psy
chol
ogic
al S
tres
s pr
essu
re t
o pr
oduc
e th
e de
sire
d ou
tcom
e an
d lik
elih
ood/
risk
of a
dver
se e
ffec
ts t
hat
may
res
ult
irres
pect
ive
of t
he le
vel o
f kn
owle
dge/
skill
/exp
erie
nce
of t
he p
rovi
der
Com
pone
nts
of C
PT C
ode
Valu
es
2) P
ract
ice
expe
nse
(47
.4%
)
in
clud
es it
ems
such
as
clin
ical
labo
r (o
ther
tha
n RD
N
wor
k), e
quip
men
t (s
cale
s, f
ood
mod
els,
nut
rient
an
alys
is s
oftw
are,
lapt
op, e
tc.)
, pat
ient
edu
catio
n m
ater
ials
, off
ice
rent
, util
ities
, per
sonn
el, e
tc.
3)
Pra
ctic
e lia
bilit
y ex
pens
e (4
.3%
)
Mal
prac
tice
insu
ranc
e –
we
pay
the
low
est
rate
s of
any
sp
ecia
lty -
$$
hund
reds
ver
sus
thou
sand
s
18
MN
T CP
T Co
des
9780
2
•M
NT
initi
al a
sses
smen
t an
d in
terv
entio
n, in
divi
dual
, fac
e-to
-fac
e, e
ach
15 m
inut
es
97
803
•M
NT,
rea
sses
smen
t an
d in
terv
entio
n, in
divi
dual
, ind
ivid
ual,
face
-to-
face
, ea
ch 1
5 m
inut
es
97
804
•M
NT,
gro
up, 2
or
mor
e in
divi
dual
s, e
ach
30 m
inut
es
CP
T co
des,
des
crip
tions
and
mat
eria
l onl
y ar
e ©
2015
Am
eric
an
Med
ical
Ass
ocia
tion.
All
Righ
ts R
eser
ved.
(s
earc
h: c
pt®
Cod
e/Re
lativ
e Va
lue
Sear
ch)
Face
-to-
Face
Tim
e/U
nit
Bille
d Fo
r an
y si
ngle
“15
min
ute
face
-to-
face
” CP
T co
de:
20
Face
to fa
ce a
ctua
l tim
e sp
ent:
1 un
it >
8
min
utes
to <
23
min
utes
2
units
> 2
3 m
inut
es to
< 3
8 m
inut
es
3 un
its >
38
min
utes
to <
53
min
utes
4
units
> 5
3 m
inut
es to
< 6
8 m
inut
es
5 un
its >
68
min
utes
to <
83
min
utes
6
units
> 8
3 m
inut
es to
< 9
8 m
inut
es
7 un
its >
98
min
utes
to <
113
min
utes
8
units
> 1
13 m
inut
es to
< 1
28 m
inut
es
Exam
ple:
15
min
utes
30
min
utes
45
min
utes
60
min
utes
/ 1
hou
r 75
min
utes
90
min
utes
/ 1
.5 h
ours
10
5 m
inut
es
120
min
utes
/ 2
hou
rs
MN
T “G
” Co
des
Hea
lthca
re C
omm
on P
roce
dure
Cod
ing
Syst
em 2
014
G02
70
•M
NT
re-a
sses
smen
t an
d su
bseq
uent
inte
rven
tion(
s)
follo
win
g 2n
d re
ferr
al in
the
sam
e ye
ar fo
r ch
ange
in
diag
nosi
s, m
edic
al c
ondi
tion
or t
reat
men
t re
gim
en
(incl
udin
g ad
ditio
nal h
ours
nee
ded
for
rena
l dis
ease
);
indi
vidu
al;
face
-to-
face
; ea
ch 1
5 m
inut
es
G
0271
•
MN
T re
-ass
essm
ent
and
subs
eque
nt
inte
rven
tion(
s)…
, gro
up (
2 or
mor
e in
divi
dual
s), e
ach
30 m
inut
es
Proc
edur
e Co
des
Appl
icab
le t
o RD
Ns
Inte
nsiv
e Be
havi
oral
The
rapy
(IB
T) fo
r O
besi
ty
22
G04
47:
Face
-to-
Face
Beh
avio
ral C
ouns
elin
g fo
r O
besi
ty, 1
5 M
inut
es
G04
43:
Face
-to-
Face
Beh
avio
ral C
ouns
elin
g fo
r O
besi
ty, G
roup
(2-
10),
30
Min
utes
IC
D-9
dia
gnos
is c
odes
for
BM
I 30
.0 k
g/m
2 or
ove
r (V
85.3
0-V8
5.39
, V8
5.41
-85
.45)
Se
rvic
e ca
n be
pro
vide
d up
to
22 t
imes
in a
12-
mon
th p
erio
d pe
r CM
S sc
hedu
le
RDN
s ca
n pr
ovid
e IB
T as
aux
iliar
y pe
rson
nel i
n pr
imar
y ca
re s
ettin
gs
RDN
s m
ust
bill
as “
inci
dent
to”
phy
sici
an s
ervi
ces
(gui
delin
es
diff
er f
or o
ffic
e-ba
sed
vs. h
ospi
tal o
utpa
tient
clin
ics)
Billa
ble
to M
edic
are;
che
ck p
rivat
e pa
yer
polic
ies
for
use
of
cod
e
Lear
n m
ore
at:
ww
w.ea
trigh
tpro
.org
/reso
urce
/pra
ctic
e/ge
tting
-pai
d/nu
ts-a
nd-b
olts
-of-
getti
ng-p
aid/
med
icar
e-pr
even
tive-
serv
ices
-obe
sity
G04
38
Annu
al w
elln
ess
visi
t; in
clud
es a
per
sona
lized
pre
vent
ion
plan
of
ser
vice
(PP
PS),
initi
al v
isit
G04
39
Annu
al w
elln
ess
visi
t; in
clud
es a
per
sona
lized
pre
vent
ion
plan
of
ser
vice
(PP
PS),
sub
sequ
ent
visi
t N
o sp
ecifi
c di
agno
sis
code
s ar
e re
quire
d, b
ut o
ne m
ust
be in
clud
ed o
n th
e cl
aim
. RD
Ns
can
prov
ide
the
AWV
unde
r di
rect
sup
ervi
sion
of
a ph
ysic
ian
(bill
as
“inc
iden
t to
” ph
ysic
ian
serv
ices
) Le
arn
mor
e at
: w
ww
.eat
right
pro.
org/
reso
urce
/pra
ctic
e/ge
ttin
g-pa
id/w
ho-p
ays-
for-
nutr
ition
-ser
vice
s/an
nual
-w
elln
ess-
visi
t-in
-med
icar
e
• • • • • • • • • •
Tele
heal
th S
ervi
ces
Und
er M
edic
are
Indi
vidu
al M
edic
are
MN
T ca
n be
pro
vide
d vi
a te
lehe
alth
U
se t
he M
NT
code
978
02 a
nd m
odifi
er “
GT”
•M
ust
use
an in
tera
ctiv
e au
dio
and
vide
o te
le-
com
mun
icat
ions
sys
tem
tha
t pe
rmits
rea
l-tim
e co
mm
unic
atio
n be
twee
n RD
N a
nd p
atie
nt
•Go
to
ww
w.e
atrig
htpr
o.or
g/re
sour
ce/p
ract
ice/
gett
ing-
paid
-in
-the
-fut
ure/
emer
ging
-hea
lth-c
are-
deliv
ery-
and-
paym
ent/
tele
heal
th f
or d
etai
ls o
n M
edic
are
M
NT
tele
heal
th
25
• • •
(Not
bill
able
to M
edic
are;
che
ck p
ayer
pol
icie
s to
det
erm
ine
use
of c
odes
)
• • • • •
• • • • • • • •
30
CPT
Code
Res
ourc
es
Med
icar
e Pe
rfor
man
ce M
easu
res:
PQ
RS C
odes
•
RDN
Med
icar
e pr
ovid
ers
can
avoi
d a
dow
nwar
d pa
ymen
t ad
just
men
t if
repo
rt o
n at
leas
t 9
mea
sure
s ac
ross
3 N
atio
nal
Qua
lity
Dom
ains
for
at le
ast
50%
of
Med
icar
e FF
S pa
tient
s.
•If
pro
vide
r se
es a
t le
ast
1 M
edic
are
patie
nt in
a fa
ce-t
o-fa
ce
enco
unte
r, m
ust
repo
rt a
t le
ast
1 cr
oss-
cutt
ing
mea
sure
(as
par
t of
th
e 9)
. •
2015
rep
ortin
g da
ta d
eter
min
es t
he d
ownw
ard
paym
ent
adju
stm
ent
(-2%
) to
be
appl
ied
in 2
017
•Pa
ymen
t in
201
5 ba
sed
on 2
013
repo
rtin
g (p
oten
tial -
1.5%
do
wnw
ard
adju
stm
ent)
•
Paym
ent
in 2
016
base
d on
201
4 re
port
ing
(pot
entia
l -2%
do
wnw
ard
adju
stm
ent)
w
ww
.eat
right
pro.
org/
reso
urce
/pra
ctic
e/ge
ttin
g-pa
id/n
uts-
and-
bolts
-of
-get
ting-
paid
Med
icar
e 20
15 P
QRS
RD
N M
easu
res
2015
PQ
RS M
easu
res
Appl
icab
le t
o RD
Ns:
PQRS
#1:
Dia
bete
s M
ellit
us:
Hem
oglo
bin
A1c
Poor
Con
trol
PQRS
#12
8: P
reve
ntiv
e Ca
re a
nd S
cree
ning
: BM
I Sc
reen
ing
and
Follo
w-u
p*
PQRS
#13
0: D
ocum
enta
tion
of C
urre
nt M
edic
atio
ns in
M
edic
al R
ecor
d*
PQRS
#18
1: E
lder
Mal
trea
tmen
t Sc
reen
and
Fol
low
-up
Plan
Q
nets
uppo
rt@
sdps
.com
*D
enot
es a
“cr
oss-
cutti
ng”
mea
sure
32
Med
icar
e Pe
rfor
man
ce M
easu
res:
PQ
RS C
odes
•
Det
ails
and
fre
e w
ebin
ar a
vaila
ble
at
ww
w.e
atrig
htpr
o.or
g/re
sour
ce/p
ract
ice/
gett
ing-
paid
/nut
s-an
d-bo
lts-o
f-ge
ttin
g-pa
id o
r ht
tp:/
/ww
w.c
ms.
gov/
Med
icar
e/Q
ualit
y-In
itiat
ives
-Pat
ient
-As
sess
men
t-In
stru
men
ts/P
QRS
/?gc
lid=
CJ3W
z5--
2b8C
FQaC
Mgo
d4m
sARg
•
PQRS
mea
sure
s an
d pr
oced
ures
upd
ated
ann
ually
•
Repo
rt P
QRS
mea
sure
s us
ing
QD
Cs (
Qua
lity
Dat
a Co
des)
Exam
ple:
30
46F
•Co
min
g in
201
8:
Valu
e M
odifi
er P
aym
ent
(tie
s PQ
RS w
ith c
ost)
The
2013
Aca
dem
y Co
ding
Sur
vey
Resu
lts
Codi
ng S
urve
y D
emog
raph
ics
Emai
l Inv
itatio
n:
Prov
isio
n of
MN
T in
Am
bula
tory
Car
e (B
illab
le)
Setti
ngs
(ACS
):
•Al
l mem
ber/
non-
mem
ber
RDN
s in
Aca
dem
y/CD
R da
taba
se;
–
Not
ret
ired
–Em
ail a
ddre
ss
–U
S re
side
nce
–To
tal E
mai
led
n =
82,
262
–To
tal R
espo
nden
ts n
= 5
,840
•
Prov
ide
&/o
r m
anag
e pr
ovis
ion
of M
NT
in A
CS n
=
3,62
8 –
Com
plet
ed e
ntire
sur
vey
n= 3
015
(~83
%)
Codi
ng S
urve
y D
emog
raph
ics:
Re
spon
se b
y Pr
actit
ione
r Ty
pe
Prac
titio
ner T
ype
Prov
ider
83%
Man
age/
Prov
12%
Man
ager
5%
Empl
oym
ent
Stat
us:
Re
spon
se b
y Pr
actit
ione
r Ty
pe
050
010
0015
0020
0025
00
IRS-
1099
W-2
Man
ager
Man
age/
Prov
Prov
ider
Prim
ary
Wor
k Se
ttin
g
Resp
onse
by
Prac
titio
ner
Type
010
020
030
040
050
060
070
080
0
Prov
ider
Man
age/
Prov
Man
ager
Mal
prac
tice
Insu
ranc
e Co
vera
ge
Resp
onse
by
Prac
titio
ner
Type
0
200
400
600
800
1000
1200
1400
Prov
ider
Man
age/
Prov
Man
ager
22.8
% o
f tot
al re
spon
dent
s do
n’t c
arry
or d
on’t
know
if th
ey c
arry
mal
prac
tice
insu
ranc
e
Med
icar
e Pr
ovid
er S
tatu
s
Resp
onse
by
Prac
titio
ner
Type
0
200
400
600
800
1000
1200
1400
Prov
ider
Man
age/
Prov
Man
ager
Yes
No
Don'
t Kno
w
Aver
age
Tim
e Sp
ent
Prov
idin
g M
NT:
Ba
sic
Serv
ices
010
020
030
040
050
060
070
080
090
0
9780
2-In
itial
9780
3 - F
/U97
804-
Gro
up
Aver
age
Tim
e Sp
ent
Prov
idin
g M
NT:
Ad
ded
Visi
ts/C
hang
e of
Con
ditio
n
0
200
400
600
800
1000
1200
G02
70-In
div
G02
71-G
roup
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
0 to
12
to 3
4 to
56
or m
ore
Mean Proportion of "Typical" Patients
Num
ber o
f Con
ditio
ns
Prov
ider
Man
ager
/Pro
vide
rM
anag
er
Com
plex
ity o
f Pa
tient
s Se
en
Resp
onse
by
Prac
titio
ner
Type
MN
T Pa
yer
Mix
Re
spon
se b
y Pr
actit
ione
r Ty
pe
020406080100
120
Prov
ider
Man
age/
Prov
Man
ager
MC
Self-
Pay
Priv
ate/
Com
mM
/A S
tate
Wel
Oth
er
PQRS
Par
ticip
atio
n
Resp
onse
by
Prac
titio
ner
Type
0
200
400
600
800
1000
1200
1400
1600
No
Answ
erYe
sN
oD
on't
know
Prov
ider
Man
age/
Prov
Man
ager
Usu
al &
Cus
tom
ary
Fee
Set
Resp
onse
by
Prac
titio
ner
Type
0
200
400
600
800
1000
1200
1400
Yes
No
Don'
t Kno
w
Prov
ider
Man
age/
Prov
Man
ager
Awar
enes
s of
Pay
er “
Caps
” by
Pra
ctiti
oner
Typ
e
0
200
400
600
800
1000
1200
1400
1600
No
Answ
erYe
sN
oD
on't
Know
Prov
ider
Man
age/
Prov
Man
ager
Sele
cted
Dis
ease
s/Co
nditi
ons
Reim
burs
ed
0.0
10.0
20.0
30.0
40.0
50.0
60.0
DMPr
e-DM
Rena
lO
besi
tyH
TNLi
pids
Percent of Respondents
Sele
cted
Con
ditio
ns R
eim
burs
ed
2006
2008
2013
Sele
cted
Dis
ease
s/Co
nditi
ons
Reim
burs
ed
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Baria
tric
Surg
ery
Failu
re to
Thriv
eEa
ting
Diso
rder
sFo
odAl
lerg
ies
GI
Diso
rder
sCe
liac
Percent of Respondents
Sele
cted
Con
ditio
ns R
eim
burs
ed
2006
2008
2013
Case
Stu
dy
A 66
yea
r ol
d fe
mal
e ha
s be
en n
ewly
di
agno
sed
with
Typ
e 2
DM
. M
D P
rogr
ess
Not
e:
Type
2 D
M, u
ncon
trol
led;
250
.02
Patie
nt r
eluc
tant
to
star
t an
othe
r m
edic
atio
n.
Refe
rral
for
MN
T, 3
vis
its
Wei
ght
: 15
5 lb
s, t
race
ede
ma
BP 1
35/7
2
H
bA1c
: 8.
4
LD
L: 1
50m
g/dl
, TG
: 27
5 m
g/dl
Case
Stu
dy
Key
item
s bi
ller
lists
on
CMS
1500
cla
ims
form
Even
if R
DN
doe
sn’t
bill
them
selv
es, y
ou s
houl
d/m
ay
need
to
prov
ide
code
s an
d in
form
atio
n in
clud
ed o
n cl
aim
– Y
OU
are
res
pons
ible
for
all s
ervi
ces
bille
d un
der
your
nam
e 1.
Com
plet
e pa
tient
con
tact
/de
mog
raph
ic
info
rmat
ion
& v
isit
docu
men
tatio
n (E
BPG
s)
2. E
nter
ICD
-9 c
ode
250.
02 o
n lin
e 21
Use
dia
gnos
is c
ode
from
the
ref
errin
g ph
ysic
ian
(PCP
); r
evie
w r
efer
ral f
orm
, MD
pre
scrip
tion,
or
call
MD
off
ice
for
diag
nost
ic (
ICD
-9)
code
.
(see
han
dout
for
sam
ple
clai
ms
form
)
Case
Stu
dy
Key
item
s to
list
on
CMS
1500
cla
ims
form
(co
nt.)
3.
Ent
er C
PT c
ode
9780
2 (in
itial
MN
T) o
n lin
e 24
d
-
List
num
ber
of M
NT
units
on
line
24g
(you
r
do
cum
enta
tion
shou
ld c
onta
in t
he n
umbe
r of
face
-to-
face
(f-2
-f)
min
utes
you
spe
nt w
ith t
he p
atie
nt
Fo
r ex
ampl
e: 6
0 m
inut
es =
4 u
nits
– b
ase
# u
nits
yo
u lis
t on
act
ual f
-2-f
tim
e sp
ent
with
pat
ient
M
odifi
ers,
if r
elev
ant
(i.e.
, Med
icar
e, T
eleh
ealth
MN
T)
-
Lis
t G
T m
odifi
er o
n lin
e 24
d in
“m
odifi
er”
colu
mn
Reim
burs
emen
t:
An A
LL M
embe
r Im
pera
tive
Sand
i Mor
ris, R
D,C
D
Indi
ana
Uni
vers
ity H
ealth
-Gos
hen
Hos
pita
l Clin
ical
Nut
ritio
n M
anag
er
IAN
D R
eim
burs
emen
t Re
pres
enta
tive
53
Your
“To
Do”
Lis
t: 1.
0 �
Prov
ide/
Bill
for
Nut
ritio
n Se
rvic
es
�M
alpr
actic
e In
sura
nce
Cove
rage
:
w
ww
.aca
dem
yper
sona
linsu
ranc
e.co
m/
�
Esta
blis
h a
Usu
al &
Cus
tom
ary
Fee
�Co
mpl
ianc
e w
ith c
urre
nt r
egul
atio
ns:
•N
PI �
HIP
PA r
equi
red
•Co
rrec
t co
ding
•
PQRS
Inc
entiv
es �
Pen
altie
s
Your
“To
Do”
Lis
t:
1.0
(con
’t)
Que
stio
ns fo
r H
ospi
tal/C
linic
Bill
ing
Dep
artm
ent
•Ar
e w
e bi
lling
for
MN
T or
nut
ritio
n se
rvic
es?
•
Wha
t in
sura
nces
are
we
in-n
etw
ork
for?
•
Are
you
awar
e th
at R
DN
s ca
n bi
ll di
rect
ly fo
r M
NT
serv
ices
? •
Are
you
awar
e th
at R
DN
s ca
n bi
ll in
clin
ic/o
ffic
e se
ttin
gs?
•Ca
n w
e ex
pand
our
ser
vice
s to
oth
er a
reas
(o
ffic
e, o
utpa
tient
, D
SMT,
clin
ics,
spe
cial
ty
prac
tices
)?
55
Your
“To
Do”
Lis
t: 2.
0
Driv
e fu
ture
EBN
P (p
ract
ice)
�
Trac
k O
utco
mes
–
Hea
lth I
mpr
ovem
ent
–Re
imbu
rsem
ent
•Pa
ymen
t ra
tes
per
Publ
ic/P
rivat
e Pa
yer
Bille
d
•D
isea
ses/
Cond
ition
s Co
vere
d •
Use
of
G-c
odes
to
prov
ide
addi
tiona
l ser
vice
(
MC
only
) �
Trac
k N
ew S
ervi
ces
Requ
ests
�
Impr
ove
Cont
ract
s N
egot
iatio
n –
Reim
burs
emen
t Ra
tes
–Ex
pand
Dis
ease
s/Co
nditi
ons
Cove
red
–Es
tabl
ish
RDN
s as
pre
ferr
ed p
rovi
ders
of
Nut
ritio
n Se
rvic
es
Your
“To
Do”
Lis
t:
3.0
�Ad
voca
te fo
r ex
pans
ion
of M
NT
bene
fit
�G
rass
root
s m
arke
ting
esse
ntia
l -
Doe
s YO
UR
heal
th p
lan
cove
r M
NT/
RDN
se
rvic
es?
-Co
ntac
t yo
ur p
erso
nal i
nsur
ance
car
rier
to d
eter
min
e nu
triti
on s
ervi
ces
cove
rage
-
Com
mun
icat
e w
ith y
our
faci
lity
to s
ee if
you
are
bi
lling
for
outp
atie
nt n
utrit
ion
serv
ices
(M
NT)
-
Med
ical
pro
fess
iona
ls a
skin
g fo
r RD
N s
ervi
ces
but
unaw
are
of
how
to
pay
for
serv
ices
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Academy of Nutrition and Dietetics, Revised January 2012
Coding, Coverage, Compensation for MNT Academy Coding and Coverage Committee
To successfully bill for nutrition services provided by RDs, practitioners need to become familiar with certain terms and procedures used on claims forms.
Definitions Codes –The standardized “language” used to describe the particular service provided (e.g. MNT) and the reason the service was necessary (e.g. the disease/condition addressed). Both the procedure and diagnosis codes are used on claims so that a decision can be made for reimbursement of the service. Current Procedural Terminology (CPT) codes- A medical code set used to identify and describe the services offered by all health care providers to the public. The CPT codes provide a uniform language to accurately describe medical, surgical and diagnostic services and allow nationwide communication among providers, patients and third party payers. Each code is comprised of five-digit numbers, eg. 97802. These codes are categorized into one of six major sections (i.e. Evaluation & Management, Anesthesiology, Surgery, Radiology, Pathology and Lab, or Medicine.) The MNT CPT codes are listed in the Medicine section. Within each of the six sections, the codes are divided into further subsections such as body systems (musculoskeletal, respiratory, etc), place of service (office visit or hospital visit) and the patient’s status (new or established patient). The CPT code set is maintained, annually updated and copyrighted by the American Medical Association (AMA), and has been adopted by the Secretary of Health and Human Services as the standard (under the Health Insurance Portability and Accountability Act-HIPAA) for reporting health care services in the US. (Source: The AMA CPT 2012, and CMS Glossary accessed from http://www.cms.gov/apps/glossary/default.asp?Letter=C&Language=English.) Healthcare Common Procedure Coding System (HCPCS)- Medicare’s National Level II Codes- A medical code set, accepted under HIPAA, that identifies health care procedures, equipment, and supplies for claim submission purposes. HCPCS Level II codes are alphanumeric codes, eg. G0270, used to identify various items and services that are not included in the CPT code set. CMS annually maintains the codes with input from other payer groups. HCPCS codes include two G codes used with Medicare Part B Medical Nutrition Therapy (G0270 and G0271) and codes for Medicare diabetes self-management training programs (G0108 and G0109). (Source: CMS’ Web page: http://www.cms.hhs.gov/apps/glossary/.) ICD-9-CM codes (International Classification of Diseases - 9- Clinical Modification) Often referred to as “diagnosis codes,” this code set is the official system for tracking disease/condition incidence in all health care settings in the US. The National Center for Health Statistics (NCHS) and CMS are the governmental agencies responsible for overseeing the ICD-9-CM. Diagnosis codes describe an individual’s medical condition that is determined by the treating physician. By law, CMS requires physicians to submit diagnosis codes for Medicare reimbursement. Physicians are the trained health care provider responsible for determining a medical diagnosis, so when listing the diagnosis code on a claim form for nutrition services provided by an RD, the RD should obtain the appropriate diagnosis code(s) from the patient/client’s physician. An example of a diagnosis code is 250.02- diabetes mellitus, type II or unspecified type, uncontrolled. Note: A new code set, ICD-10-CM, will replace the current ICD-9-CM codes effective October 1, 2013. (Source: AMA International Classification of Diseases; Physician ICD-9-CM 2012 & CMS Glossary: http://www.cms.hhs.gov/apps/glossary/default.asp?Letter=I&Language=English#Content.) NPI- The National Provider Identifier (NPI) is a unique, government issued, standard identifier mandated by HIPAA that replaces providers’ other provider numbers from Medicare and other private payers. Once assigned, the 10 digit numeric NPI stays with a provider for life. For more information go to the Academy’s Web page at: www.eatright.org/coverage.
Academy of Nutrition and Dietetics, Revised January 2012
Coding, Coverage, Compensation for MNT--CPT and HCPCS Codes Relevant to Nutrition Services Academy Coding and Coverage Committee Medical Nutrition Therapy (MNT) CPT and HCPCS codes Compared with other CPT codes, the following MNT CPT codes best describe the services that RDs provide to patients/clients receiving medical nutrition therapy services for a particular disease or condition. The codes can be used among private insurance companies, depending on the coding and billing details listed in the RD’s contract with the payer. CMS requires use of these codes for the Medicare Part B MNT benefit by enrolled RD providers who perform MNT services for diabetes, non-dialysis kidney disease and kidney transplants.
97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes 97803 re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes 97804 group (2 or more individual(s)), each 30 minutes CPT codes, descriptions and material only are copyright @2012 American Medical Association. All Rights Reserved.
CMS also established HCPCS codes for use with Medicare covered services, effective for dates of service on or after January 1, 2003. These new G codes should be used when additional hours of MNT services are performed beyond the number of hours typically covered, (3 hours in the initial calendar year, and 2 follow-up hours in subsequent years with a physician referral) when the treating physician determines there is a change of diagnosis or medical condition that makes a change in diet necessary.
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. G0271 Medical Nutrition Therapy; reassessment and subsequent interventions(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. Source: Center’s for Medicare & Medicaid Services (CMS) Medicare Claims Processing Manual, Chapter 4- Part B Hospital, accessible at: http://www.cms.hhs.gov/manuals/downloads/clm104c04.pdf
Other CPT codes for RDs-Private insurance payers, but not Medicare, may accept other CPT codes, such as the Education and Training codes (98960-62); Medical Team Conference (99366 and 99368); Telephone Services (98966-68); and On-line Medical Evaluation – (98969). Check your payer contract, policies or call the payer provider relations for more code policies. Physicians who offer RD provided nutrition services at their clinics may be able to bill certain third private insurance companies (NOT Medicare Part B) as “incident to” physician’s services. For additional “incident to” details go to “providing the service & billing” at www.eatright.org/mnt; for other code details go to www.eatright.org/coverage. Diabetes Self-Management Training (DSMT). Medicare Part B covers diabetes self-management training (DSMT) services when these services are furnished by a certified provider at an accredited program. Other private payers may also cover DSMT. This program is intended to educate beneficiaries in the successful self-management of diabetes and includes instructions in self-monitoring of blood glucose; education about diet and exercise; an insulin treatment plan (as indicated); and motivation for patients to use the skills for self-management. The following HCPCS codes are used for DSMT:
G0108 - Diabetes outpatient self-management training services, individual, per 30 minutes. G0109 - Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes. Source: CMS Medicare Benefit Policy Manual, Chapter 15 accessible at: http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf.
Academy of Nutrition and Dietetics, Revised January 2012
Coding, Coverage, Compensation for MNT; ADA Billing Primer – Frequently Asked Billing Questions; Academy Coding and Coverage Committee What information is typically included on the claims form?
• The name of the insured policy holder, and the patient/client name, gender, address, phone number, date of birth, social security number
• Name of the patient’s insurance, the individual insurance number and group number • CPT code and number of code units for the provider’s service, eg. RD uses MNT codes • ICD-9-CM code (from referring physician) • Referring MD name and NPI; and RD provider name and NPI • Date of service and charge for the service • Signature date (Signature on File)
What is involved with hiring a biller to handle claims for nutrition services? RDs may find it helpful and time/cost-effective to hire a biller to handle claims for nutrition services. Billers are familiar with the various claims forms, codes and billing procedures for third party payers. Billers usually are paid based on the volume of the practice, so a biller can get anywhere from 4 to 7% of the RD’s payments. Although there are several national groups that provide billing services and resources (see “Billing Information” resources on the Academy’s Web page: www.eatright.org/coverage), talking to local private practice RDs or physicians can be a great source for identifying a local biller. Or, consult your local Yellow Pages (look up “Medical Billers”) or conduct your own Internet search (query “medical billing”) to identify billers in your area. What claims forms are used to bill for nutrition services? The CMS1500 and CMS1450 (UB-04) forms are accepted by Medicare, however for Part B (outpatient) services, claims for MNT provided by enrolled RDs are usually submitted on the CMS1500 form. Some hospitals may only have access to the CMS1450, typically used to bill for Medicare Part A (inpatient) services, however in these cases, CMS will accept the CMS1450 form for Medicare Part B outpatient MNT services. Many private insurance companies use the CMS1500 form. For more information on the CMS1500 form, go to the Academy’s Web page at www.eatright.org/mnt, then click on “providing the service & billing” and then “forms”. If the client/patient is self-paying for the nutrition services, and the RD is not filing a claim with an insurance company, a Superbill is manually completed by the RD and provided to the client/patient. A Superbill is a pre-printed, or created form that itemizes and describes the services and fees provided to the patient/client. For information on Superbills go to www.eatright.org/coverage, then “presentations.” What other resources does the Academy have to help me successfully code and bill for nutrition services? Articles on setting fees: Duester, J., Michael, P.; Myers E. Tips for Contract Negotiations and Establishing MNT Rates. J AM Diet Assoc. 2001; 101 (6): 624-626.
Duester, J; Building your Business-Setting Your Fees: A Cost-Based Approach. J AM Diet Assoc., 1997; 97, Issue 10, Supplement: S129-S130.
Dietetic Practice Group (DPG) resources: Many DPGs have resources available to their members, check their web page for information. For example, the Nutrition Entrepreneurs (NE) DPG has a mentoring program where RD members can contact another DPG member for discussion/networking etc. For more information visit the NE web site at www.nedpg.org.
Making Nutrition Your Business. An essential resource for any dietetics professional considering a switch to private practice, consulting, writing, or speaking. Available at www.eatright.org/shop. Access Medicare and other Coding and Coverage Information in the Members Section of the Academy’s Web site; www.eatright.org/mnt and www.eatright.org/coverage.
• Medicare MNT Resources HIPAA and Compliance Resources
Academy of Nutrition and Dietetics, Revised January 2012
• Private Insurance & Employers Resources The MNT Works Kit & List of Educational Sessions
• Academy Reimbursement Representatives’ Contact Information (for the affiliates and DPGs)
The medical nutrition therapy (MNT) CPT codes are used by many third party payers, including Medicare. These codes best describe the MNT services that registered dietitians provide to patients.
97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes.
97803 reassessment and intervention, individual, face-to-face with the patient, each 15 minutes.
97804 group (2 or more individual(s)), each 30 minutes.
Additional Codes Used by RDs (refer to CPT book for full code description): G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second
referral in same year for change in diagnosis, medical condition, or treatment regimen, individual, face-to-face with the patient, each 15 minutes.
G0271 group (2 or more individual(s)), each 30 minutes.
G0108 Diabetes outpatient self-management training services, individual, per 30 minutes.
G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes.
98960–98962 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family).
98966–98968 Telephone assessment and management service provided by a qualified nonphysician health care professional.
98969 Online assessment and management service provided by a qualified nonphysician health care professional, internet or electronic communications.
99071 Educational supplies, such as books, tapes, and pamphlets, provided by the physician (or other qualified health care professional) for the patient’s education at cost to physician.
99366 and 99368 Medical team conference, with and without the patient and/or family.
CPT codes, descriptions and material only are copyright ©2009 American Medical Association. All Rights Reserved.
Frequently Used Codes for Nutrition Services
Medical Nutrition Therapy
MNTWorks
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