As diabetes prevalence increases, the importance of diabetes self-management training (DSMT) and medical nutrition therapy (MNT) becomes undeniable. To empower patients, optimize health outcomes, and ensure sustainable access, healthcare systems must integrate DSMT and MNT into diabetes care protocols. This article highlights the critical role of registered dietitians (RDs) and nutrition professionals in providing these services and the substantial benefits they offer to patients.
DSMT: A Key to Improved Diabetes Management:
By enabling patients to take control of their blood sugar, DSMT significantly improves health outcomes. Patients can lead more active and fulfilling lives with reduced diabetes symptoms and a lower risk of serious complications. Additionally, effective diabetes management through DSMT can decrease hospital admissions and medical interventions, benefiting both patients and the healthcare system.
Empowering Patients through DSMT and MNT:
Registered Dietitians (RDs) and nutrition professionals are well-suited to provide Diabetes Self-Management Training (DSMT) and Medical Nutrition Therapy (MNT) services. To ensure quality, these providers must be accredited by organizations like the American Diabetes Association or the Association of Disease Care & Education Specialists, which are approved by the Centers for Medicare & Medicaid Services (CMS).
CMS guidelines state that RDs and nutrition professionals can provide DSMT services if they are part of an accredited DSMT entity or work under the supervision of a qualified healthcare provider.
RDs offer a personalized approach to diabetes care, considering each patient’s unique dietary habits, preferences, lifestyle, and nutritional needs. By crafting tailored care plans, RDs empower patients to achieve and maintain optimal blood sugar control and insulin management.
To further enhance care, RDs utilize continuous blood sugar monitoring tools like remote patient monitoring services. By analyzing glucose data, RDs can make timely adjustments to meal plans and dietary recommendations.
Practical guidance on meal planning and preparation is a cornerstone of RD services. By setting SMART goals and providing ongoing support, RDs help patients create balanced, diabetes-friendly meals that align with their health goals.
Medicare Coverage for DSMT:
A patient’s primary healthcare provider (like a doctor, nurse practitioner, physician assistant, or clinical nurse specialist) must first determine the need for Diabetes Self-Management Training (DSMT). This determination must be documented in a written or electronic referral. The provider must also be actively participating in Medicare or have officially opted out of the program.
Medicare covers DSMT as a Part B benefit, not Part A. This means that the patient’s primary care provider, who is managing their diabetes, must maintain a comprehensive diabetes care plan within the patient’s medical records.
Initial DSMT Referral Requirements:
A DSMT referral should include the following information:
- Patient Information:
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- Name
- Diagnosis (ICD-10-CM code) and supporting documentation
- Learning, language, or social determinants of health
-
DSMT Details:
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- Need for DSMT (specify group or individual)
- If individual, specify one or more of the following conditions:
- Type 1 diabetes
- Type 2 diabetes
- Gestational diabetes
- (Note: For FQHCs and RHCs, individual DSMT is the only payable option)
- Number of initial hours (maximum 10)
- Topics to be covered
Provider Information:
-
- Signature of the treating provider
Follow-up DSMT Referral Requirements:
For follow-up DSMT, the treating provider must maintain a diabetes care plan in the patient’s medical record. The referral should include:
Patient Information:
-
- Name
- Diagnosis (ICD-10-CM code) and supporting documentation
DSMT Details:
-
- Need for follow-up DSMT
- Maximum of two hours of individual or group training per year
Provider Information:
-
- Signature of the treating provider
Important Note: DSMT and MNT cannot be billed on the same service date for the same patient or incident to a physician’s or NPP’s professional services, as per National Coverage Determination 180.1.
The approved locations for in-person Diabetes Self-Management Training (DSMT) include:
- Hospital outpatient departments
- Critical access hospitals
- Private physician practices
- Registered dietitian (RD) practices
- Independent clinics, such as freestanding Federally Qualified Health Centers (FQHCs) or independent Rural Health Clinics (RHCs)
- Home health agencies
- Skilled nursing facilities
- Pharmacies
- Durable medical equipment companies
Excluded Places of Service:
- Hospital inpatient facilities
- Nursing homes
- Kidney dialysis facilities
Initial and Subsequent Medical Nutrition Therapy (MNT):
- Initial MNT Referral:
- Physician referral
- Diagnosis of diabetes, renal disease, or kidney transplant within the past 36 months
- Confirmation of previous MNT services provided by a Registered Dietitian (RD) or other qualified nutrition professional
First Year of MNT:
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- Minimum of three hours of one-on-one counseling
Subsequent Years of MNT:
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- Minimum of two hours of counseling
- Additional hours may be covered if a physician determines a change in the patient’s medical condition, diagnosis, or treatment regimen necessitates adjustments to the MNT plan.
Comprehensive Care Planning and Documentation: Providers must create detailed care plans for DSMT and MNT services, documenting them in the patient’s medical record. These plans should include the physician’s original order, any special conditions, and any changes to the training order or referral.
Accurate Coding for Effective Reimbursement: Precise diagnosis and coding are essential for successful DSMT and MNT programs and proper reimbursement. Codes should be assigned to the highest level of specificity, as supported by the medical record. Providers should document family history, personal history, and any organ transplants.
Relevant ICD-10-CM Codes for Diabetes and DSMT:
Diabetes Types and Complications:
Type 1 Diabetes:
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- E10.9: Type 1 diabetes mellitus without complications
- E10.65: Type 1 diabetes mellitus with hyperglycemia
Type 2 Diabetes:
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- E11.9: Type 2 diabetes mellitus without complications
- E11.65: Type 2 diabetes mellitus with hyperglycemia
- E11.22: Type 2 diabetes mellitus with diabetic chronic kidney disease
Additional Factors:
Patient Education and Counseling:
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- Z71.3: Dietary counseling and surveillance
- Z71.89: Other specified counseling
Treatment and Medical History:
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- Z79.4: Long-term insulin use
- Z79.84: Long-term oral hypoglycemic drug use
- Z94.0: Kidney transplant status
Coding Guidelines for Diabetes Self-Management Training (DSMT):
Time-Based Coding: Since DSMT and MNT codes are based on time, accurate documentation of session duration is crucial for proper Medicare reimbursement.
HCPCS Level II Codes: Utilize the following codes to bill for DSMT services:
- G0108: Individual session (30 minutes)
- G0109: Group session (2 or more, 30 minutes)
Telehealth Coverage: Following the updates on November 13, 2023, DSMT services are now permanently covered by Medicare for both audio-only and audio/visual telehealth sessions.
Coding for Medical Nutrition Therapy (MNT):
Direct Billing for MNT Services:
The following MNT services can only be billed by the Registered Dietitian (RD) or nutrition professional who directly provides them:
- Initial Assessment and Intervention (Individual): 97802 (15 minutes)
- Re-assessment and Intervention (Individual): 97803 (15 minutes)
- Group Medical Nutrition Therapy: 97804 (30 minutes)
- Reassessment and Subsequent Intervention (Individual): G0270 (15 minutes)
- Reassessment and Subsequent Intervention (Group): G0271 (30 minutes)
Telehealth Eligibility for MNT Services:
Except for G0271, these codes are now permanently eligible for telehealth services, allowing for both audio-only and audio/visual consultations.
Optimizing RCM for DSMT and MNT
Diabetes Self-Management Training (DSMT) and Medical Nutrition Therapy (MNT) play crucial roles in the services provided by a revenue cycle management (RCM) company, especially in chronic care management for healthcare providers. DSMT and MNT are essential for managing diabetes and other metabolic disorders, helping patients maintain better health outcomes, and lowering overall healthcare costs. In the RCM context, these services translate to accurate and complete documentation, coding, and reimbursement, which are vital for maximizing revenue for healthcare providers.
For DSMT and MNT services, precise coding and thorough documentation are essential. RCM companies must ensure that billing processes capture all aspects of these services, allowing healthcare providers to be reimbursed appropriately for the time-intensive work involved in patient education and dietary counseling. Moreover, these services often involve multiple sessions and patient follow-ups, requiring careful management of billing cycles and claim submissions.
Effective RCM for DSMT and MNT services not only supports healthcare providers financially but also aligns with value-based care models by improving patient engagement and self-care capabilities. Ultimately, integrating DSMT and MNT services into RCM operations boosts provider revenue and supports a more sustainable healthcare system focused on preventive care.