Kelly Posted Mon 06th of June, 2011 20:43:22 PM
What code can I use for an RN spending 30 minutes with a Medicare patient on diabetes diet education and insulin teaching? The RN is not accredited with any diabetes programs. Can I charge a '98960' or 'G0108' without the RN being accredited in diabetes education? If the patients insurance is not Medicare what can we charge for the same service at 30 minutes for an individual?
SuperCoder Answered Tue 07th of June, 2011 15:17:03 PM
Only DSMT programs that have submitted their Certificate of Recognition from the AADE, ADA or IHS may bill Medicare for DSMT services. Other payors might not require this, assuming any practice that bills using DSMT service code G0108 has a certificate.
Contact each of the private payers to see if they require a DSMT program to be recognized by the ADA or by any other accreditation organization. Many private payers do not require ADA recognition, or any other kind of accreditation. They may also want you to use CPT codes 98960 for an individual for each 30 min.