Coding

Hello, 

We are looking to have a diabetic educator on board in our busy antepartum testing unit & I wanted help regarding codes for diabetes teaching for our patients. I do know that the dietary counseling code is Z17.3. Do I need to put in the diabetes in pregnancy codes along with it? Are there any other codes that are applicable? Any pointers/links? All help is appreciated. 

Thank you.

------------------------------
SJ
------------------------------

Good Morning
We actually do a lecture of the use of CDE and how to bill at our coding course in May & September as it is a frequently requested topic.   This year we will be in Houston in mid-May if you are able to attend.  In general any diabetic education provided by the physician/provider will utilize E/M codes and typically based on time.  To utilize the outpatient E/M codes (99201-99215) would involve including the O code for diabetes in pregnancy management.  There are other CPT codes that can be used, thought not always recognized by payers - such as the 98960 (education and training for patient self management by a qualified non physician health care professional using a standardized curriculum, face to face with patient).  There is also the CPT code G0108 for government payers (diabetes outpatient, self management raining services; individual per 30 minutes).  There are specific CMS rules that indicate when these CPT codes will be covered - I would refer you to the CMS website to review such.  There is also a CPT code for medical nutrition therapy (97802) that may be utilized; and then there are a bunch of HCPCS "S" codes that some providers have had success with when submitting claims.   Prior authorization may be required for your CDE/provider to do diabetic education - so may be best to confirm this with the payer to avoid denials.  Also, some payers will not pay for diabetic counseling codes outside of the E/M codes and so we always recommend that you review your payer contracts to see if these other codes (98960, G0108, 97802) can be submitted/billed.  You may need to make a case for the value of this service with the payer. 

Hope this helps - and Happy New Year
Vanita

------------------------------
Vanita Jain, MD
Chair, SMFM Coding Committee
------------------------------

Original Message:
Sent: 12-26-2018 20:41
From: Sheveta Jain
Subject: Diabetes counseling

Hello,

We are looking to have a diabetic educator on board in our busy antepartum testing unit & I wanted help regarding codes for diabetes teaching for our patients. I do know that the dietary counseling code is Z17.3. Do I need to put in the diabetes in pregnancy codes along with it? Are there any other codes that are applicable? Any pointers/links? All help is appreciated.

Thank you.

------------------------------
SJ
------------------------------

Personally, I think the utilization of a CDE is not a great move.  It is much better to get an advanced practitioner and have them function as a provider and also get a CDE credential. They can then prescribe medications for diabetes, see patients, give nutritional counseling, and also bill.  As Vanita says, often the CDE codes used are not reimbursed.

------------------------------
Brian Iriye
------------------------------

Original Message:
Sent: 12-31-2018 10:29
From: Vanita Jain
Subject: Diabetes counseling

Good Morning
We actually do a lecture of the use of CDE and how to bill at our coding course in May & September as it is a frequently requested topic.   This year we will be in Houston in mid-May if you are able to attend.  In general any diabetic education provided by the physician/provider will utilize E/M codes and typically based on time.  To utilize the outpatient E/M codes (99201-99215) would involve including the O code for diabetes in pregnancy management.  There are other CPT codes that can be used, thought not always recognized by payers - such as the 98960 (education and training for patient self management by a qualified non physician health care professional using a standardized curriculum, face to face with patient).  There is also the CPT code G0108 for government payers (diabetes outpatient, self management raining services; individual per 30 minutes).  There are specific CMS rules that indicate when these CPT codes will be covered - I would refer you to the CMS website to review such.  There is also a CPT code for medical nutrition therapy (97802) that may be utilized; and then there are a bunch of HCPCS "S" codes that some providers have had success with when submitting claims.   Prior authorization may be required for your CDE/provider to do diabetic education - so may be best to confirm this with the payer to avoid denials.  Also, some payers will not pay for diabetic counseling codes outside of the E/M codes and so we always recommend that you review your payer contracts to see if these other codes (98960, G0108, 97802) can be submitted/billed.  You may need to make a case for the value of this service with the payer.

Hope this helps - and Happy New Year
Vanita

------------------------------
Vanita Jain, MD
Chair, SMFM Coding Committee

Original Message:
Sent: 12-26-2018 20:41
From: Sheveta Jain
Subject: Diabetes counseling

Hello,

We are looking to have a diabetic educator on board in our busy antepartum testing unit & I wanted help regarding codes for diabetes teaching for our patients. I do know that the dietary counseling code is Z17.3. Do I need to put in the diabetes in pregnancy codes along with it? Are there any other codes that are applicable? Any pointers/links? All help is appreciated.

Thank you.

------------------------------
SJ
------------------------------

Thank you Dr. Iriye.  This is more of choice made by my corporation to expand our unit. I really appreciate your input. I think the option to hire advanced practitioner may be more practical.

------------------------------
Sheveta Jain
------------------------------

Original Message:
Sent: 01-07-2019 14:50
From: Brian Iriye
Subject: Diabetes counseling

Personally, I think the utilization of a CDE is not a great move.  It is much better to get an advanced practitioner and have them function as a provider and also get a CDE credential. They can then prescribe medications for diabetes, see patients, give nutritional counseling, and also bill.  As Vanita says, often the CDE codes used are not reimbursed.

------------------------------
Brian Iriye

Original Message:
Sent: 12-31-2018 10:29
From: Vanita Jain
Subject: Diabetes counseling

Good Morning
We actually do a lecture of the use of CDE and how to bill at our coding course in May & September as it is a frequently requested topic.   This year we will be in Houston in mid-May if you are able to attend.  In general any diabetic education provided by the physician/provider will utilize E/M codes and typically based on time.  To utilize the outpatient E/M codes (99201-99215) would involve including the O code for diabetes in pregnancy management.  There are other CPT codes that can be used, thought not always recognized by payers - such as the 98960 (education and training for patient self management by a qualified non physician health care professional using a standardized curriculum, face to face with patient).  There is also the CPT code G0108 for government payers (diabetes outpatient, self management raining services; individual per 30 minutes).  There are specific CMS rules that indicate when these CPT codes will be covered - I would refer you to the CMS website to review such.  There is also a CPT code for medical nutrition therapy (97802) that may be utilized; and then there are a bunch of HCPCS "S" codes that some providers have had success with when submitting claims.   Prior authorization may be required for your CDE/provider to do diabetic education - so may be best to confirm this with the payer to avoid denials.  Also, some payers will not pay for diabetic counseling codes outside of the E/M codes and so we always recommend that you review your payer contracts to see if these other codes (98960, G0108, 97802) can be submitted/billed.  You may need to make a case for the value of this service with the payer.

Hope this helps - and Happy New Year
Vanita

------------------------------
Vanita Jain, MD
Chair, SMFM Coding Committee

Original Message:
Sent: 12-26-2018 20:41
From: Sheveta Jain
Subject: Diabetes counseling

Hello,

We are looking to have a diabetic educator on board in our busy antepartum testing unit & I wanted help regarding codes for diabetes teaching for our patients. I do know that the dietary counseling code is Z17.3. Do I need to put in the diabetes in pregnancy codes along with it? Are there any other codes that are applicable? Any pointers/links? All help is appreciated.

Thank you.

------------------------------
SJ
------------------------------

Thank you so much Dr. Jain. 
This is so helpful. I really appreciate your response. 

Happy new year to you as well. 
Sheveta

------------------------------
Sheveta Jain
------------------------------

Original Message:
Sent: 12-31-2018 10:29
From: Vanita Jain
Subject: Diabetes counseling

Good Morning
We actually do a lecture of the use of CDE and how to bill at our coding course in May & September as it is a frequently requested topic.   This year we will be in Houston in mid-May if you are able to attend.  In general any diabetic education provided by the physician/provider will utilize E/M codes and typically based on time.  To utilize the outpatient E/M codes (99201-99215) would involve including the O code for diabetes in pregnancy management.  There are other CPT codes that can be used, thought not always recognized by payers - such as the 98960 (education and training for patient self management by a qualified non physician health care professional using a standardized curriculum, face to face with patient).  There is also the CPT code G0108 for government payers (diabetes outpatient, self management raining services; individual per 30 minutes).  There are specific CMS rules that indicate when these CPT codes will be covered - I would refer you to the CMS website to review such.  There is also a CPT code for medical nutrition therapy (97802) that may be utilized; and then there are a bunch of HCPCS "S" codes that some providers have had success with when submitting claims.   Prior authorization may be required for your CDE/provider to do diabetic education - so may be best to confirm this with the payer to avoid denials.  Also, some payers will not pay for diabetic counseling codes outside of the E/M codes and so we always recommend that you review your payer contracts to see if these other codes (98960, G0108, 97802) can be submitted/billed.  You may need to make a case for the value of this service with the payer.

Hope this helps - and Happy New Year
Vanita

------------------------------
Vanita Jain, MD
Chair, SMFM Coding Committee

Original Message:
Sent: 12-26-2018 20:41
From: Sheveta Jain
Subject: Diabetes counseling

Hello,

We are looking to have a diabetic educator on board in our busy antepartum testing unit & I wanted help regarding codes for diabetes teaching for our patients. I do know that the dietary counseling code is Z17.3. Do I need to put in the diabetes in pregnancy codes along with it? Are there any other codes that are applicable? Any pointers/links? All help is appreciated.

Thank you.

------------------------------
SJ
------------------------------