Chiropractic care and nutrition consulting

How to get reimbursed, and time components vs. Medical Decision Making (MDM) for nutrition consulting

HOW DOES ONE DOCUMENT AND GET PAID for nutrition consulting and for going over laboratory results? Are these services covered by insurance? Also, does insurance pay for a “report of findings?”

Common procedures

To begin with, there are CPT codes for Medical Nutrition Therapy (listed below). However, we do not typically recommend using them because according to the American Medical Association, if a doctor provides Medical Nutrition Therapy, then Evaluation & Management (E/M) codes (e.g., 99202, 99212) should be reported.

Reviewing lab work results and performing nutrition consulting are very common procedures provided in chiropractic offices nationwide. These visits may include evaluating blood/urine reports, initiating a treatment plan, providing the prognosis, risks and benefits of treatment options, instructions for treatment follow-up and importance of compliance.

This type of “counseling and/or coordination of care” can be reported with E/M codes (e.g., 99202, 99212). According to the E/M guidelines (as of Jan. 1, 2021), providers must choose either time or Medical Decision Making (MDM) when reporting new patient and established patient E/M codes.

Nutrition consulting and time components

The time component range for code 99212 is 10-19 minutes. The 99212 MDM elements are minimal for the amount of problems and data to review.

As far as risk of complications and morbidity/mortality, that will fall under the minimal category. The time component range for code 99213 is 20-29 minutes. The 99213 MDM elements are “low” for the amount of problems. An example is two or more self-limiting problems such as low-back pain and neck pain. The data to review is considered “limited.” Another example is ordering X-rays and reviewing X-rays or requiring the assistance of an independent historian (e.g., parent, guardian, spouse, surrogate). As far as risk of complications and morbidity/mortality, that will fall under the low category.

Example #1

The patient is complaining of indigestion and stomach discomfort. The patient feels that these complaints have increased lately and could be due to anxiety and stress.

The patient stated the indigestion is “pretty bad” (pain scale of 7/10). Today’s visit included a review of the lab work, and diagnostic tests that the patient brought in for review (e.g., blood tests, MRIs).

After a review of the records, recommendations were made (e.g., eat smaller meals, exercise, drink more water, avoid certain foods, goals, more rest, less strenuous work, less treatment, more tests, get a second opinion). The patient was given the opportunity to ask questions. The patient consented to care. Total time spent for this session was 10 minutes (99212). The MDM component for this encounter can used instead of the time component.

Example #2

A report of findings was provided to the patient today. The patient was given the diagnosis and schedule for care. Following this discussion, the patient had concerns and questions about the possibility of surgical intervention. We went over the risks and benefits.

The patient had questions about the importance of sticking to the treatment schedule. The patient asked if I could educate his/her spouse on the diagnosis and schedule of care. Recommendations were made. The patient was given the opportunity to ask questions. The patient consented to care.

Total time spent for this session was 10 minutes (99212). The MDM component for this encounter can be used instead of the time component.

Nutrition codes

The Medical Nutrition Therapy (MNT) codes are:

• 97802: Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes.
• 97803:Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes.
• 97804:Medical nutrition therapy; group (two or more individuals), each 30 minutes.

MARTY KOTLAR, DC, CPCO, CBCS, is the president of Target Coding. Over the last 12 years he has helped hundreds of chiropractors, physical therapists and acupuncturists with compliance as it relates to billing, coding, documentation, Medicare and HIPAA. He is certified in compliance, a certified coding specialist, a contributing author to many coding and compliance journals, and a guest speaker at many state association conventions. He can be reached at 800-270-7044, TargetCoding.com or drkotlar@targetcoding.com.