Billing Nutrition Counseling in a Chiropractic Setting

Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional who may report evaluation and management services, they are supposed to report an Evaluation and Management or Preventive Medicine service code instead of the MNT codes.

Preventive Medicine

Preventive Medicine codes 99381-99387, 99391-99397, G0402 are more comprehensive than MNT and include:

• an age and gender appropriate history and examination
• counseling/anticipatory guidance/risk factor reduction interventions
• ordering of laboratory/diagnostic procedures

Documentation needs to clearly identify that this service is not for treatment of a disease-related diagnoses and some payers require may modifier 33.

Another possibility could be the 99401-99404 codes which are far less comprehensive than the previously listed preventive medicine codes and do not require the history and exam. Therefore, they are paid at a lesser rate (e.g., Medicare allowed $36 for 99401 vs $155 for 99386). While these codes are not payable by Medicare, many other commercial payers do cover these services.

Medical Nutrition Therapy (MNT)

MNT codes (97802-97804, G0270, G0271) are timed codes which are to be used by registered dieticians/nutritionists who can NOT report Evaluation and Management (E/M) codes. Use codes 97802-97804 for the original referral for an initial and/or subsequent visit.

Because these are time based codes, carefully watch the time limitations which are generally outlined in the payer's policy. For example, see Medicare's NCD 180.1.  If a registered dietician's services are required for medical nutrition therapy for a subsequent evaluation in the same year, due to a diagnosis change or provider-requested change, this must be well documented and either code G0270 or G0271 should be reported (as appropriate).

For non-Medicare patients, the following codes might be appropriate:

• S9465 Diabetic management program, dietitian visit
• S9470 Nutritional counseling, dietitian visit

Tips:

• Review payer policies to ensure that you are meeting their guidelines. For example, many have covered diagnosis codes and MNT codes have very specific rules which must be followed.
• Preventive medicine codes are typically not payable with an E/M visit on the same date of service due to overlapping requirements.

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