Marilyn Posted Tue 06th of May, 2014 17:14:07 PM
Does anybody know what procedure codes Horizon BCBSNJ uses for RDN's? We use 9780x but they state the code is out of scope of practice or our claims are denied for " we are in network" but no payment. They can't tell me why. They tell us that only Licenced Nutritionist/Dietician can perform this type of service using the 9780x code(s).Hello... We tell them that they are, with still no understanding at their end.
SuperCoder Answered Wed 07th of May, 2014 13:21:51 PM
I am not sure what "RDN" means, although I assume it stands for "registered dietician/nutritionist," based on the rest of the question. As noted in the question, codes 97802-97804 (medical nutrition therapy) represent services that registered dieticians and other licensed nutrition qualified professionals provide to individuals or groups of individuals with chronic conditions. Thus, they would seem to be the right codes for services provided by a registered dietician/nutritionist. I cannot explain why the payer in question is not paying for those services for this based on the information provided. I would encourage you to appeal the affected claims and see if the appeals process will reveal the correct solution to the problem.