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97802

Marilyn Posted Wed 11th of December, 2013 12:04:31 PM

Humana denied claim for dx 27800 is inconsistent with procedure code "97802", but the dx is cross referencing to the procedure code. What would be an acceptable dx for Humana?

SuperCoder Answered Thu 12th of December, 2013 20:51:30 PM

If you have one of these insurance plans, you still need to ask that you confirm that nutrition services are covered. To do this, call your insurance provider and ask what nutrition services are provided for under the two CPT codes:

CPT 97802 (nutrition initial visit)
CPT 97803 (nutrition follow-up visit)
If they ask for a diagnosis code, you will need to get that from your physician.

Unfortunately, many insurance providers do not reimburse for the diagnosis code for obesity (278.0). However, what you can do is see if your insurance will cover for a diagnosis that is a complication of obesity, like Type 2 Diabetes or gastrointestinal esophageal reflux disease and there are other diagnoses that qualify.

Plan to pay any co-pay you have and know any deductibles that apply. And if any insurance claim is denied, it is your responsibility as the patient to pay any remaining balance in full.

Marilyn Posted Wed 25th of June, 2014 11:34:20 AM

If there is a diabetes and HTN due to obesity, would diabetes be primary, being obesity be listed as the third dx?

SuperCoder Answered Wed 09th of July, 2014 10:19:05 AM

Yes, you should list diabetes/HTN dx primary to obesity.

Thanks!!

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