Billing and Coding for Childhood Obesity Prevention and Treatment Julie DeSaire, Billing Manager Miramont Family Medicine

HCPCS Coding  S9945 – Patient Education, non-physician provider, individual per session  S9446 – Patient Education, non-physician provider, group, per session  S9449 – Weight Management Classes, non- physician provider, per session  S9451 – Exercise Classes, non-physician provider, per session

HCPCS Coding  S9452 – Nutrition Classes, non-physician provider, per session  S9454 Stress Management Classes, non-physician provider, per session  S9455 – Diabetic Management Program, (DMP) group session  S9460 – DMP, Nurse Visit  S9465 – DMP, Dietician Visit  S9470 – Nutritional Counseling, dietitian visit

CPT Coding  Medical Nutrition Therapy Assessment includes review and analysis of 1) medical, nutrition, and medication history; 2) physical exam; 3) anthrometric measurements; and 4) laboratory test values.

CPT Coding  Nutrition Therapy Therapy includes 1) diet modification; 2) counseling and education; 3) disease self- management skills training, and 4) administration of specialized therapies such as medical foods, intravenous or tube feedings.

CPT Coding  Medical Nutrition Therapy –97802 Medical Nutrition Therapy, initial assessment and intervention, individual, face to face with patient, each 15 minutes –97803 Re-assessment and intervention, individual, face to face with patient, each 15 minutes –97804 Group, each 30 minutes

CPT Coding  Evaluation and Management Codes    Make sure that you have enough documentation to meet the guidelines for using the above codes.

ICD-9 Coding  Obesity, unspecified  Morbid Obesity  Overweight Payors generally have benefit exclusions regarding Obesity

ICD-9 Coding  Co-Morbidities –Always use a co-morbidity as your primary diagnosis rather than an obesity code

Questions?