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
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Vanita Jain, MD
Chair, SMFM Coding Committee
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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.
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SJ
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