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Diabetic Education

Loni Posted Tue 15th of October, 2019 17:28:11 PM
If a nurse practitioner offers individual diabetic education to patients seen in the office, which code is correct: G0108 or 98960?
SuperCoder Answered Wed 16th of October, 2019 04:12:47 AM

Hi Loni,

In code G0108, diabetic self-management training provided to the patient with the skills necessary to control diabetes. This service is provided to an individual patient in an outpatient setting. The program includes educating the patient about self-monitoring of blood sugar, diet management, and exercise. For insulin dependent patients, the program includes an insulin treatment plan. This service is provided by a certified diabetes educator, or CDE; registered dietician, or RD; or other qualified provider.

Use G codes for professional healthcare procedures and services that would otherwise be coded in CPT® but for which there are no CPT® codes. Medicare provides coverage for diabetes self-management education and training only by a certified provider, but not by nurse practitioner.

Whereas, in CPT 98960, a nonphysician healthcare professional uses a standard curriculum to educate a patient about his or her disease or disorder, like diabetes. He/she also provides training on how to manage it more effectively. This education and training service enable the patient and or the caregiver or family to effectively manage the disease. The healthcare professional spends 30 minutes with an individual patient.

Qualified, nonphysician healthcare professionals typically include nurses, physician assistants or PAs, nurse practitioners or NPs, physical therapists, respiratory therapists, trained social worker and similar medical professionals, instead of physician providers. Hence, CPT 98960 is appropriate to use.

Hope this helps!

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