Navigating insurance in your private practice can be confusing. Evolving legislation and coverage for telehealth services only further complicates the matter.
Whether you are in-network with insurance companies or create superbills for your clients, it is beneficial to be well-acquainted with insurance codes. This way, you’ll save time every instance you create a claim.
Here at Healthie, we hear a lot of questions from our nutrition community about which CPT and ICD-10 codes to use for documentation.
Here’s what you need to know about insurance billing codes for dietitians:
ICD-10 Diagnosis Codes
ICD stands for “International Classification of Diseases.“ These codes are used by physicians and medical coders to assign medical diagnoses to individual patients. Registered dietitians cannot make medical diagnoses. However, these codes are used on CMS 1500 forms, referrals, and superbills.
Common ICD-10 diagnosis codes you will see on referrals are:
- Z71.3 – Dietary counseling and surveillance (typically used for preventative services)
- E11.___ –Type 2 Diabetes (the ___ specifies if any complications are present)
- E66.0 – Obese due to excess calories
- E66.3 – Overweight (weight management referrals)
CPT, or Current Procedural Terminology, codes are the codes that identify the service you provided as a healthcare professional.
The three most common medical nutrition therapy (MNT) codes that dietitians use on claims are listed below. Public insurers, like Medicare and Medicaid, as well as private insurance carriers, can use these CPT codes.
- 97802 – For an initial assessment, face-to-face
- 97803 – For a follow up visit or reassessment, face-to-face
- 97804 – For a group visit (2 or more individuals)
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. Keep in mind, insurance billing is in units of 15 minutes each. This means a 1-hour initial assessment is 4 units.
One common question we receive is, “Does my claim change if submitting an insurance claim for telehealth services?” The answer is yes!
First, you (or your client) should always check with the insurance company to evaluate coverage for virtual services. Then, when filing your claim, it is necessary to add a modifier to the end of the CPT code for video counseling services.
The two most commonly used modifiers are:
- GQ – Asynchronous Telecommunications systems, such as a pre-recorded video
- GT – Interactive Audio and Video Telecommunications systems, including a live video conferencing session
Many insurance companies are rapidly changing their coverage for telecommunications, so always perform an eligibility check before providing your services.
Most insurance companies limit the number of sessions covered per calendar year. If a client exhausts their benefits, and their referring physician determines a change in diagnosis that requires your service, you will use G codes to bill for the rest of the year.
The most common G codes are:
- G0270 – 15-minute one-on-one session for a reassessment due to a new or change in diagnosis
- G0271 – 30-minute group session for a reassessment due to a new or change in diagnosis
You can find out more about G codes here.
This is not a recommendation to use any of these codes for your documentation. Please ask insurance companies you are in-network with for the latest updates and preferences. Insurance billing varies from company to company and, state to state. This list is a glimpse at the frequently-used codes.
For more information on insurance billing and coding, please visit these resources:
- CMS Telehealth Services: Department Of Health And Human Services, Centers for Medicare & Medicaid Services
- Guide to Insurance and Reimbursement: Today’s Dietitian website, by Krista Ulatowski, MPH, RDN
- ICD-10 Codes: Academy of Nutrition and Dietetics website
- Medicare basics for RDNs: becoming a provider: Academy of Nutrition and Dietetics website