97802-Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with

Our claims are getting denied, the rep is indicating we can only use 1 unit. The patient is being seen for an hour by the nutritionist so we are billing 4 units. Can anyone provide any insight to this.

Comments

  • Medically unlikely Edit

    Lisa R Berger, CPC
    Denials Management Team
    Revenue Integrity & Coding Advisor
    EXT 50839, Mail Stop NCA3-01
    lrberger@gundersenhealth.org



  • When I looked it up there were no MUE
  • I didn't see an MEU either, have you looked at the reference in the IOM: Pub 100-03, CH 1: 180.1
  • Hello,
    Some MUEs are not published to providers. Check CMS MUEs website and there is a excel spreadsheet where you can enter the cpt code. It should give you a valid number of units.  Keep in mind, that you can an appeal with supporting documentation. I hope this helps.  

    Sent from Yahoo Mail on Android

    On Thu, May 5, 2016 at 11:47 AM, Michelle Suitor wrote: I didn't see an MEU either, have you looked at the reference in the IOM: Pub 100-03, CH 1: 180.1
  • Hi John,

    I checked the CMS MUE CSV for MUE the code did not come up. I do plan to appeal



    Joyce Alexander, CPC, CPC-P,COC, CEMC, CMRS,CPMA, ICD-10 Proficient

    Unity Health Care, Inc.

    1220 12th St. SE

    Washington, D.C. 20003

    (202) 715-6564

    Email: jalexander@unityhealthcare.org



  • It is not an MUE issue. One hour visits (4 units) for initial MNT is completely normal and typical and we bill with 4 units all the time without issue. I've been billing for MNT for many years and never heard of such a denial. I'd get back on the phone and demand answers, this makes no sense. Good luck.
  • Thank you Erica, We are going to appeal.

    Joyce Alexander, CPC, CPC-P,COC, CEMC, CMRS,CPMA, ICD-10 Proficient
    Unity Health Care, Inc.
    1220 12th St. SE
    Washington, D.C. 20003
    (202) 715-6564
    Email: jalexander@unityhealthcare.org


  • edited May 2017
    Well that's my point, you shouldn't have to appeal something when the denials are incorrect. Get on the phone and make them fix the issue. Rep says one unit only, you say show it to me in writing, if they can't, then you get a supervisor. Don't take no for an answer.





    Thank you Erica, We are going to appeal.

    Joyce Alexander, CPC, CPC-P,COC, CEMC, CMRS,CPMA, ICD-10 Proficient
    Unity Health Care, Inc.
    1220 12th St. SE
    Washington, D.C. 20003
    (202) 715-6564
    Email: jalexander@unityhealthcare.org


  • Will do, thank you so much. I was at a loss. I will definitely follow your instructions.

    Joyce Alexander, CPC, CPC-P,COC, CEMC, CMRS,CPMA, ICD-10 Proficient
    Unity Health Care, Inc.
    1220 12th St. SE
    Washington, D.C. 20003
    (202) 715-6564
    Email: jalexander@unityhealthcare.org


  • Great... and it might help if you give them examples of previously paid claims with 4 units. I'm sure you have many if this is a service you bill for regularly. Good luck!
  • I found the information on their web site that states billing multiple units is allowed:
    http://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00126165

    page 2
    CPT or HCPCS


    Joyce Alexander, CPC, CPC-P,COC, CEMC, CMRS,CPMA, ICD-10 Proficient
    Unity Health Care, Inc.
    1220 12th St. SE
    Washington, D.C. 20003
    (202) 715-6564
    Email: jalexander@unityhealthcare.org


  • edited May 2017
    It could be a benefit max issue for the patient as well; I've had experience running into that. So either it could be accurate, or a mistake on their part with keeping track the number of visits and/or time spent. A call to a provider rep may clear that up for you. 
    Jen Vasquez, CPC, CEMC 
    Sent from my Verizon Wireless 4G LTE smartphone

  • I thought about that too, but they have denied all claims.



    Joyce Alexander, CPC, CPC-P,COC, CEMC, CMRS,CPMA, ICD-10 Proficient

    Unity Health Care, Inc.

    1220 12th St. SE

    Washington, D.C. 20003

    (202) 715-6564

    Email: jalexander@unityhealthcare.org



  • edited May 2017
    Joyce - I just want to take a moment to thank you for taking the time and effort to have a complete signature line with your name, company name, address, phone and email address, as you do.. It’s amazing to me, as I scroll down the Part B emails how many people do not - yet they ask questions where the answer may depend on their specialty or their locality. Thank you.

    Don Self & Associates, Inc

    305 Senter Ave, Whitehouse, TX 75791
    903 871-1172 fax 480-247-5650
    donself@donself.com web: www.donself.com
    free webinars at www.donself.com

    DISCLAIMER: This email should not pose any visual, auditory or sensory defects in the average reader. If you are now or have been dead or stupid in the past, this email will probably not help you. If you know anyone reading this email who is not from earth - you should immediately seek medical attention. If you have been or plan to be an imbecile in the future, please do not read this disclaimer. These warnings are not valid in the state of Hawaii, Alaska or New Hampshire.

  • You are welcomeJ



    Joyce Alexander, CPC, CPC-P,COC, CEMC, CMRS,CPMA, ICD-10 Proficient

    Unity Health Care, Inc.

    1220 12th St. SE

    Washington, D.C. 20003

    (202) 715-6564

    Email: jalexander@unityhealthcare.org



  • edited May 2017
    Hi Don,

    I agree with you on having a full/complete signature, but have not found how to adjust it in this forum (even with looking through the help files). If you know how to update this, could you post the instructions for the rest of us.

    Thanks in advance,

    Michelle Suitor
  • You do it through your email system on your replies :-)

    Allison K. Hiott, CCS, CPC, CPC-I
    Remote Professional Coding Specialist
    Reimbursement & Advisory Services Division
    Greenville, SC (Eastern Standard Time Zone)

    Altegra Health | The Promenade at Howard Hughes Center | 6601 Center Drive | Suite 300 | Los Angeles, CA 90045
    C (864) 303-4861 |Allison.hiott@altegrahealth.com



    AltegraHealth.com

    Strategic Analytics | Litigation Support | Coding & Reimbursement | ICD-10 Solutions | Compliance & Internal Audit | Valuation & Transactions | Revenue Cycle & IT Management

  • edited May 2017
    Michelle,

    I apologize that I can’t tell you how to do it using the online forum as I’m never on the online forum and have no idea what it takes for that. I use an email client (apple mail) similar to Outlook or other email programs. I am set up with each listserv for them to send me emails that comes to my inbox and then is sorted into separate folders for each listserv.

    In my email program, I’ve gone into Preferences and set up different signature lines. This one is my “default” (although I do change the disclaimer often to keep folks on their toes since I know that the majority never read them anyway).

    I’m sorry I can’t tell you how to do it. I would if I could.

    Don


    Don Self & Associates, Inc

    305 Senter Ave, Whitehouse, TX 75791
    903 871-1172 fax 480-247-5650
    donself@donself.com web: www.donself.com
    free webinars at www.donself.com

  • edited May 2017
    I think some employers don’t allow their employees to use email on public forums and restrict the use of where their emails go.



    It protects their organization from being exposed from someone’s question……..or at least, that’s how I look at it.



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com




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