AI Solutions for Healthcare

Coding for Medical Nutrition Therapy (MNT)

Medical nutrition therapy [MNT] is utilized for specific conditions (diabetes, renal failure, elevated cholesterol) whereby a nutritionist or dietician meets face to face with the patient to educate them on dietary choices, and/or cooking alternatives pertaining to their condition. National Coverage Determination for MNT [NCD 180.1] affords each patient a minimum of three hours for the first year of MNT and two hours per subsequent year with exceptions for additional hours due to a change in condition, diagnosis or treatment schedule.

Examples of appropriate utilization may include newly diagnosed diabetic patients, existing diabetic patients with a change in their condition and/or medications to control their blood glucose levels, or patients who have renal disease and have dietary restrictions.  MNT is not considered ‘incident to’ and should be only reported by the nutritionist or registered dietician that performed the services.  The allowed services per year and coverage by condition may vary from payer to payer; however, most payers do not cover MNT services for weight loss management.

Table 1 displays procedure codes for medical nutrition therapy services and variations by service

Code Initial Reassessment Individual Group Minutes DX/TX change
97802 Yes No Yes No 15 No
97803 No Yes Yes No 15 No
97804 N/A N/A No Yes 30 No
G0270 No Yes Yes No 15 Yes
G0271 No Yes No Yes 30 Yes

What should your health plan expect regarding claims submissions medical nutrition therapy services?

  • Claims with procedure codes 97802, 97803, 98704, G0270 and G0271 submitted by dieticians, nutritionists or providers specializing in endocrinology
  • Claims with procedure codes 97803, G0270 and G0271 submitted for patients with changes in their diagnosed condition or treatment regimen

What should your health plan consider as outlier utilization or unlikely medical nutrition therapy?

  • Patients with a high units of service per calendar year for MNT services [initial, reassessment, subsequent]
  • Providers outside the expected specialties submitting claims for any MNT service
  • Providers billing a high-volume of initial MNT units of service per patient without subsequent or reassessment MNT services

How can the Codoxo Forensic Platform assist your health plan with identifying emerging risks, trends and outlier claims for medical nutrition therapy? 

  • The AI engine and detectors identify patterns, volume and frequency across all peer groups and claims allowing customers to identify, analyze and respond to potential FWA and efficacy issues
  • The Query tool allows users to build custom reports, tailored to their organizational needs, at the line, claim or aggregate level

If you are an existing customer, please contact your Customer Success representative or support@codoxo.com for assistance with this topic.  If you would like more information or to setup a demonstration of the Codoxo Forensic Platform, please contact sales@codoxo.com.

References: 

CMS, Medicare Coverage Database, National Coverage Determination, 180.1, Medical Nutrition Therapy
https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=252&ver=1

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