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How to Code for Obesity and Medical Nutrition Therapy March 25, 2022

CPT code for Nutrition and Obesity

The National Institutes of Health (NIH) declares that obesity is a significant public health concern in the United States. Obese individuals are at higher risk of developing heart disease, strokes, and cancer. Furthermore, the number of obese people worldwide has increased from 26 million in 1975 to 422 million. 

Not everyone knows that genetics, environmental, and metabolic factors can contribute to obesity.

We will outline the proper way to code for obesity and medical nutrition therapy (MNT) for healthcare providers.

Coding Medical Nutritional Therapy

The obesity treatment can range from therapy to surgery. It is evident that surgery should be a last resort and only be considered for severely obese individuals. Meanwhile, the following list below contains medical nutrition therapy code(s) that dietitians use. Private insurance carriers, besides public insurers, such as Medicare and Medicaid, can also use these MNT CPT codes.

Passing the midpoint constitutes a unit of time. The billing process for codes 97802 and 97803 would take eight minutes. You can bill a maximum of eight units per code for the same patient on the same day. If a healthcare provider spends 22 minutes with a patient, they can only bill 97802 or 97803 once since they’ve not reached the midpoint of the next 15 minutes.

Code 97804 follows the same rules as MNT CPT codes 97802 and 97803. However, the code 97804 is for 30 minutes each. To bill the first unit of 97804, you must spend at least 16 minutes with the patient. For the second unit, you must spend 46 minutes, and so on. Consider consulting an expert in coding if you find this issue troubling.

You should refrain from making only one common mistake: reporting these sessions as incident-to. That’s why it is not a good idea to report 97802-97804 incident-to-a doctors since they are nutritionist-specific codes. Make sure to use the nutritionist’s national provider identifier. 

The modifier AE Registered dietician can be added to the MNT code. For clarification, this modifier denotes the services of a nutritionist or registered dietitian. Several insurers, including Medicare, may have a policy regarding the frequency of MNTs and how many visits a patient can have. If applicable, check the payer’s policy and require the patient to sign an advance beneficiary notice (ABN).

The dietitian (or qualified nutritionist) reviews the patient’s diagnosis and treatment plan in their changing medical condition. In addition, their job is to perform a nutrition screening and discuss the patient’s specific dietary needs. Including telehealth services, the provider spends 15 minutes with each patient discussing long-term healthy eating. For this reassessment and any subsequent interventions, report this code every 15 minutes. The first year of medical nutrition therapy consists of only three one-on-one sessions.

The rules apply in the same way with the MNT CPT code G0270. However, in a dietitian-led therapy session, there must be at least two people (e.g., a group).

The CPT Codes for Weight Loss and Obesity Screening 

CPT 99401

Description: Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 15 minutes.

CPT 99402

Description: Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 30 minutes.

CPT G0446

Description: Annual, face-to-face intensive behavioral counseling (IBT) for cardiovascular disease (CVD), individual, 15 minutes.

CPT G0447

Description: Face-to-face behavioral counseling for obesity, 15 minutes.

CPT G0473

Description: Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes.

Codes for Body Mass Index (BMI) Z68.XX

Obesity codes:

Clinicians usually obtain a patient’s BMI while they take their vital signs. The provider needs to code the patient’s BMI with the appropriate obesity code in such cases.

On the other hand, ICD-9 CM 278.00 is a billable medical code that indicates a diagnosis on a reimbursement claim, but it should only be used on claims with a service date before September 30, 2015.

Summary

Since it’s easy to get unhealthy foods and there are fewer healthy options available in many places, obesity is likely to remain a nationwide issue. While making the right choices for ourselves, we can also counsel our patients on doing the same.

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