Medical Billing Forum
Coding => Coding => : Cherylwilli August 14, 2009, 03:03:34 PM
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I have a nutritionist who isn't familiar with CPT codes and billing insurance companies. The nutritionist has a patient who was referred from an OB. The patient is pregnant and obese. The OB wants patient, who is in her first trimester to keep her weight gain to 15 pounds. Since my other providers are in mental health, I'm not sure if I should code this for something other than obesity (278.00). Can someone advise me? Thanks.
Cheryl
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You will want to check your state scope of licensing for coverage, but normally for Medical Nutritional Therapy (MNT) you would use CPT codes 97802 97803 97804.
I had a small LRD at one time but she was very small and mostly cash because many of the carriers did not cover it back then. In some states it's a mandated benefit for certain diagnosis. I can't advise you on the diagnosis since I don't have the patient's chart. you have to assign the diagnosis that corresponds to the documentation in the patient's chart. IMO you should leave that up to the provider, there could be other conditions documented.
For those carriers that are covering it, it's a very small amount of visits and a very minimal payment. With Medicare they only cover MNT for renal disease and diabetes.
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Oops my mistake, I said CPT code but meant DX. The nutrionist has no idea and doesn't know anything about any codes to bill insurances. I agree payment is minimal. Thanks.
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The provider knows how to diagnose correct? In that case then she really needs to get a coder. She had better know how to diagnose, from there the diagnosis is documented and from there it's translated from the chart documentation to an ICD-9 code. This is one thing you cannot take lightly and no one here can really tell you what diagnosis to put down because although that is a valid dx code for obesity we don't have the chart to determine if any other diagnosis was documented nor should we/could we guess.
If you are not an experienced coder I highly suggest letting the provider know that this is out of your scope of services.
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Not to mention the obesity codes that denote it complicate pregnancy
649.10-649.13 Which is probably somewhere she needs to look. She has 2 conditions, pregnancy and obesity. Being overweight myself, I know that it complicates pregnancy, because by nature you gain additional weight from that, but the more weight you gain, the more issues you have. Also being severly overweight has an adverse affect on the pregnancy. Just as Linda stated we don't know what code to have you use because we don't have access to the chart. The physician needs to either take a class geared towards her specialty, or hire a coder/biller. Because of the low reimbursements I personally wouldn't hire 2 people, but get someone who could do both.
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Is she just unsure as to what order to put the diagnoses? Or does she not understand the ICD-9 system? If she doesn't know what order to put them in, she should code the first diagnosis as the main or primary reason for the visit, and then so on. The patient is obese, and pregnant, is the main reason for the visit due to the pregnancy? And the complications that the obesity brings to it? Then the correct pregnancy diagnosis would be primary followed by the obesity. Also, what did the OB put on the script?
Michele
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The patient is obese, and pregnant, is the main reason for the visit due to the pregnancy? And the complications that the obesity brings to it? Then the correct pregnancy diagnosis would be primary followed by the obesity. Also, what did the OB put on the script?
It is important to note that all our advice is completely MOOT if this stuff isn't documented in the patient's charge. If it wasn't documented it wasn't done. That's why I wouldn't be comfortable giving dx codes w/out at LEAST knowing what's in the chart and that's my point. The provider has to go back into the chart to see what diagnosis was documented.
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The patient is obese, and pregnant, is the main reason for the visit due to the pregnancy? And the complications that the obesity brings to it? Then the correct pregnancy diagnosis would be primary followed by the obesity. Also, what did the OB put on the script?
It is important to note that all our advice is completely MOOT if this stuff isn't documented in the patient's charge. If it wasn't documented it wasn't done. That's why I wouldn't be comfortable giving dx codes w/out at LEAST knowing what's in the chart and that's my point. The provider has to go back into the chart to see what diagnosis was documented.
Understood, I pointed out that although 278.00 ( a code I know so well) is for obesity...look at the other ones. Its to stress the point that you shouldn't be putting dx codes down without authorization. I agree 100% that the physician should give her dx, or hire a coder if she isn't sure how to properly code it herself. I don't mind giving out a code, because regardless of what we do, those that don't want to heed the advice will "google" it or look in a ICD-9 book and pick a code. I refuse to say the correct code to use is 649.12 when I have no earthly idea if it is or not.