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Reimbursement/Coding

Reimbursement/Coding .

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Reimbursement/Coding

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  1. Reimbursement/Coding

  2. THE INFORMATION REGARDING REIMBURSEMENT IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY AND REPRESENTS NO STATEMENT, PROMISE, OR GUARANTEE BY THE JOHNSON & JOHNSON DIABETES INSTITUTE, LLC CONCERNING LEVELS OF REIMBURSEMENT, PAYMENT, OR CHARGE. SIMILARLY, ALL CPT AND HCPCS CODES ARE SUPPLIED FOR INFORMATIONAL PURPOSES ONLY AND REPRESENT NO STATEMENT, PROMISE, OR GUARANTEE BY THE JOHNSON & JOHNSON DIABETES INSTITUTE, LLC THAT THESE CODES WILL BE APPROPRIATE OR THAT REIMBURSEMENT WILL BE MADE. IT IS NOT INTENDED TO INCREASE OR MAXIMIZE REIMBURSEMENT BY ANY PAYOR. WE STRONGLY RECOMMEND THAT YOU CONSULT YOUR PAYOR ORGANIZATION WITH REGARD TO ITS REIMBURSEMENT POLICIES.

  3. Using SMA tool code for a shared visit Go to Patient Cases section in your book and review the following: • Kenny, April and 8 peers & parents • Visit is planned for 90 min: vitals, MNT by RD, brief consult with HCP & peer discussion of lapses in self-mgmt • Code for this visit using tool

  4. Coding for SMA • What determines the 4th digit? • What determines the 5th digit? • What education code is used? • How long does the education have to be? • What CPT code is most likely?

  5. Example: Code diabetes first: 250.XX Code also manifestation: 250.5 Retinopathy

  6. Coding for SMA • 4th digit? Complications/manifestations • 5th digit? Glycemia controlled vs. uncontrolled • What education code is used? 97804 • How long does the education have to be? 30m • What CPT code is most likely? 99213

  7. DSME and MNT Complimentary • Every single patient should receive BOTH: • Diabetes Self-Management Education (DSME) • 10 hrs in initial year • 2 hrs in all subsequent years • Medical Nutrition Therapy (MNT) • 3 hrs in initial year • Extra hrs can be requested and reimbursed • 2 hrs in all subsequent years

  8. Avoiding paybacks

  9. Nurse and Provider Completed Pt Completed/Provider Reviewed Quick, Simple and Scan it!

  10. DO THE MATH

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