A Complete Guide to Medical Nutrition Therapy CPT Codes

CPT Codes

Medical Nutrition Therapy (MNT) is an evidence-based approach to treat certain chronic conditions with custom-tailored nutrition plans. Certified and registered nutritionists provide counselling to successfully meet your dietary needs and prevent or treat chronic disease.

We all know that the right and balanced diet is important for your body to function properly. For example, physical fitness, even internal feelings, sleep cycle, and thinking process is highly dependent on our food intake.

Therefore, it is crucial to keep a close eye on your diet. Particularly, those who are struggling with chronic diseases must have regular check-ups and interventions with a dietitian.

Because medical nutrition therapy can play a significant role in reducing complications associated with diabetes as well as Chronic  Kidney Disease. So, when you visit a Registered Dietitian (RD), he/she uses the Academy of Nutrition and Dietetics guidelines to counsel patients. Which can help them to improve their lifestyle as well as self-management skills.

Due to the rising prevalence of diabetes in the United States, the demand for medical nutrition therapy has increased. It is anticipated to rise in the upcoming years which will propel the growth of the US clinical nutrition market.

So, the patient flow at healthcare facilities has increased. As a result, the administrative burden related to medical coding and billing has also been increased.

Moreover, the recent changes in terms of medical coding and insurance policies have made billing and coding extremely complicated.  So, in order to streamline your RCM, you must have in-depth knowledge about the coding guidelines related to MNT.

Eligibility Criteria

Before diving into further discussions, let it be clear what is the criteria to be eligible for an MNT insurance plan. A patient must have:

  • Diabetes.
  • Renal disease.
  • Received a kidney transplant within the last 36 months and
  • Received a referral from their treating physician.

Understanding CPT Codes for MNT

CPT codes are the shortened form of Current Procedural Terminology. CP codes are an integral part of the medical billing process. Insurance companies get information about medical procedures and treatments that patients received, through these codes.

Therefore, healthcare providers must understand the fact that accurate CPT coding is crucial to get maximum payment collections. However, proper medical documentation is critical to support the accuracy of this coding.

So, in order to get reimbursed, make sure that your coding staff has a complete understanding of the procedural (CPT) and diagnosis (ICD-10) codes.

The Most Common CPT Codes 

Five-digit CPT codes are either numeric or alphanumeric, depending on the category.

It’s worth mentioning here that the CPT codes describe medical procedures and treatments. While  ICD code identifies a diagnosis and medical condition.

You’ll list the ICD code separately on the CMS1500 claim. Do not confuse CPT codes with ICD codes! However, this article contains the most common MNT codes that dietitians use while preparing medical claims.

  • 97802 – For an initial assessment, face-to-face, 15 minutes per unit
  • 97803 – For a follow-up visit or reassessment, face-to-face, 15 minutes per unit
  • 97804 – For a group visit (2 or more individuals), 30 minutes per unit

When creating a Superbill or filling out a CMS 1500 form, you will also have to specify the number of units and your fee per unit. CPT codes 97802 and 97803 should be unit priced; four units = 60 minutes, and six units = 90 minutes.

Document MNT Services

Appropriate documentation plays a vital role in the entire healthcare revenue cycle management. Because medical coders take the information about patients’ diagnosis, treatments, medical equipment, and services from the clinical documentation.

A slight error in this information can lead to claim denials. Which slows down the revenue collections management. So, in order to obtain maximum reimbursements, you must pay close attention to accurate and appropriate documentation.

Moreover, government insurance programs and private sector insurance companies require that you submit complete and accurate documentation.

What Information Do I Need to Document?

The American Dietetic Association (ADA) has developed the Nutrition Care Process and Model as a tool to guide RDs through the critical thinking process of providing professional services.

Documentation using the format of the Nutrition Care Process Model has replaced the previously used Subjective, Objective, Assessment, and Plan (SOAP) format.

However, you should make sure that the documentation for MNT contains the following essentials

  • Receipt of referral and name of primary RD.
  • Time (start and stop) and date of visit.
  • Medical diagnosis (Lab data and measurements.
  • Demographic and biochemical data, measurements.
  • Nutrition Assessment – food & nutrition history; client history.
  • Baseline intake data; pertinent anthropometrics and physical findings.
  • Nutrition diagnosis.
  • Learning needs assessment related to MNT; barriers.
  • Clinical and behavioural goals — care plan.
  • Interventions — MNT or education provided.
  • Adherence potential.
  • Scheduling of follow-up appointments.

No doubt, coding for medical nutrition therapy is different and complicated in nature as compared to other specialities. But with the implementation of innovative solutions, you can save your healthcare facility from financial loss.

For this purpose, you can acquire the assistance of certified medical coders, having extensive industry experience. You should keep in mind that accurate coding is not only essential from a financial point of view but also from a compliant perspective.

Medical Billing Benefits is a dependable healthcare news wire. That keeps you updated with the constant evolution in the fields of medical coding and billing. Subscribe to our Newsletter to stay up-to-date with the latest happenings in the medical industry.

Related Tag: An Outline of CPT Coding In Medical Billing

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