Medical Billing Forum
Coding => Coding => : ste April 08, 2011, 10:03:06 PM
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Getting nutritional counseling paid is based on medical necessity and Aetna's Clinical Policy Bullitin #49 addresses this issue. CPT Code 97802 is covered in the policy if selection criteria are met. The ICD-9 codes V65.3 and 272.0 are indicated in the CPB, but in order for selection criteria to be met one of the ICD-9 V85.2-V85.4 codes must be included. Selecting one of these 16 codes specifies the BMI within a narrow range.
For example, an adult male patient 6 foot 1 inches tall that weighs 235 pounds has a BMI of 31 (from BMI table). The corresponding ICD-9 V85 code is V85.31. This code needs to accompany V65.3 and 272.0 on the CMS-1500 if nutritional therapy (97802) is to be considered medically necessary.
Or is 272.2 and V65.3 enough to make 97802 medically necessary?
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The claim should be coded appropriately, not to establish carrier rules on medical necessity. You need the chart notes to establish this.