Imagine you’re shopping at a new grocery store. When you go to check out your weekly haul the cashier doesn’t scan each item to tally up the bill. Instead, he eyeballs the items you’ve placed on the conveyor and declares that you owe $350.
Hard pass, right?
You wouldn’t be willing to pay a bill calculated this way because you want to know the exact value of each item you’ve elected to purchase. Fair enough. Insurance payers feel the same way, which is why they rely on ICD-10 (International Classification of Disease) codes to tell them the most detailed story.
ICD-10 codes are like unique price tags attached to the valuable services you provide as a dietitian. They give insurance companies precise information on the type of care you’ve delivered. By selecting the right codes and attaching them to your services, you increase your chances of getting paid the correct amount for your expertise and services – quickly and without any headaches.
Navigating the world of ICD-10 codes might feel confusing at first. In this article, we’ll break down some of the top questions dietitians have when it comes to navigating the coding system:
Keep reading to demystify ICD-10 codes and uncover some common codes other dietitians use in their practices, including ICD-10 code for obesity, ICD-10 code for overweight, ICD-10 code for dietary counseling, and more.
ICD-10 codes are a standardized system developed by the World Health Organization (WHO). These codes are used worldwide to classify and diagnose health conditions.
US healthcare providers use a slightly different version of these codes referred to as ICD-10 Clinical Modification, or ICD-10-CM for short:
Out in the wild, you’re likely to see both flavors of ICD codes referred to simply as “ICD-10 codes” or “ICD codes.” For the sake of simplicity, we will follow a similar convention in this article.
In medical billing and reimbursement ICD-10 codes are distinct from Current Procedural Terminology, or CPT codes. ICD codes focus on diagnoses, conditions, and reasons for seeking care whereas CPT codes describe specific procedures and services.
Here are a few ways the two codes differ for dietitians:
As stated earlier, you need to include ICD-10 codes on both CMS-1500 forms when billing insurance companies directly and on any Superbills you provide directly to patients.
ICD-10 codes are diagnosis codes. It’s out-of-scope for dietitians to make a medical diagnosis so the most direct way to get the right code for a client you’re working with is from their referring healthcare provider.
If a client comes directly to you without a referral, and you believe they have a medical condition that requires dietary intervention, you can reach out to the primary care physician to request a referral that includes the correct ICD-10 code.
When it comes to how to find ICD codes, there are different avenues available. Here are some common ones:
Next up: Let’s explore some common ICD codes used by dietitians.
Dietitians are critical partners in providing interventions and therapies for people living with obesity. Including an ICD-10 code for obesity on insurance claims justifies the medical necessity of your dietary counseling or therapy.
The main ICD-10 code for obesity is E66 - Overweight and obesity. Additional numeric codes are added to this root to provide richer context on the factors contributing to the obesity:
Dietitians often record both obesity and Body Mass Index (BMI) ICD-10 codes. BMI codes fall in the Z68 range and provide further quantitative information about a client’s health which can help strengthen the case for reimbursement. Note that BMI adult codes are for persons 20 years of age or older, whereas BMI pediatric codes are for use for persons 2-19 years of age.
Tracking BMI also allows you to see changes in a client’s body composition as a result of dietary interventions and therapies. You should measure and record BMI at regular intervals since BMI-specific ICD codes may change even if the obesity code remains the same.
For example, if you documented the codes E66.09 + Z68.42 on a CMS-1500 form you would be indicating that your client is obese due to excess calories and is an adult with a BMI in the range of 45.0-49.9.
Alt = Image of section 21 from a CMS-1500 form indicating to enter the primary ICD-10 code in field A and the secondary ICD code in field B..
According to the WHO, a BMI over 25 is considered overweight, while a measurement over 30 is classified as obese.
Although there is much overlap in the care dietitians provide to obese and overweight clients, obesity is a more complex disease that can adversely affect other facets of a client’s health – including cardiovascular issues, diabetes, and hypertension.
Due to the differences between the two conditions, insurance companies have different criteria for covering interventions. For example, they may also emphasize preventive care for overweight individuals.
The ICD-10 code for Overweight (E66.3 Overweight) is just one in the range of codes that fall under E66 blanket of Obesity. It indicates that a client’s status is overweight rather than obese (BMI of 25.0 - 29.9). Much like the codes for obesity, it can be accompanied by a Z68 code to further contextualize with BMI.
There are a variety of codes dietitians use for dietary counseling. Which specific ICD-10 code for dietary counseling you choose will depend on why a particular client needs your expert services. As a dietitian, you can use these codes to document and communicate the nature of the dietary counseling you’re providing.
Using the appropriate code ensures that you’re accurately tracking and billing for your services, whether that be general dietary counseling, diabetes management, or even dietary care for pregnant women.
In this section we’ll take a look at a few codes, including the general ICD-10 code Z71.3 and these more specific codes:
The ICD-10 code Z71.3 is typically reserved for preventive dietary counseling services.
Using it ensures accurate compensation for your services, but it also helps to streamline other aspects of care:
Here’s how the codes might come to life for an adult female you’re treating for obesity who has a BMI of 31.0. Note the inclusion of a CPT code to also reflect the services being provided:
According to the CDC, more than 37 million Americans suffer from diabetes, and approximately 90-95% of them have type 2 diabetes. Since a person diagnosed with type 2 diabetes needs to be an active participant in managing their condition, dietitians often play a critical role in counseling clients on nutritional and lifestyle interventions.
The umbrella diabetes type 2 ICD-10 code is E11. However, there are more codes underneath E11 containing a greater level of detail. When choosing codes for reimbursement, the most granular code that maps to the health condition you’re treating will help to justify the necessity of your services.
ICD-10 code for type 2 diabetes mellitus with hyperglycemia
An example of a more granular code is E11.65, which is the ICD-10 code for type 2 diabetes mellitus with hyperglycemia. This code is more specific than the broader E11 code discussed above because it not only indicates that the client has Type 2 diabetes, but also specifies that the client has elevated blood glucose levels, or hyperglycemia. This provides more information about the patient's current condition to insurance payers.
The goal when working with a client who has type 2 diabetes with hyperglycemia is to help them achieve better control over blood sugar and reduce the risk of further health complications. This means interventions associated with the ICD-10 code for type 2 diabetes mellitus with hyperglycemia could include the following:
There are a few different ICD-10 codes associated with diabetic neuropathy. The presence of neuropathy indicates an increased risk of complications that need to be taken into account with planning dietary strategies.
E11.40 is the specific ICD-10 code for diabetes Type 2 with neuropathy, where the neuropathy is unspecified. It's a general code used when the details about the neuropathy haven’t been provided.
Note that "unspecified" codes are often seen as a temporary solution. When additional information becomes available, you should update the ICD-10 code for diabetes type 2 with neuropathy to a more specific code that accurately describes the patient's condition.
Let’s look at the distinction between mononeuropathy and polyneuropathy to better understand why this is so important:
This code indicates that a single nerve or nerve group is affected. With diabetes, mononeuropathy often manifests as damage to a specific nerve in the extremities, such as the wrist or face. Common examples include carpal tunnel syndrome, femoral neuropathy, or cranial nerve palsies.
Polyneuropathy is a more generalized nerve disorder where multiple nerves throughout the body are affected. Diabetic polyneuropathy is a common complication characterized by nerve damage that can affect various parts of the body, particularly the extremities.
Recommendations may focus on maintaining stable blood sugar levels and optimizing nutrient intake to support nerve health throughout the body.
Your role as a dietitian is to provide nutrition therapy and counseling in alignment with a client’s overarching healthcare needs. ICD-10-CM codes help you properly document why they are receiving your care, justify the medical necessity of your services, and ensure proper billing, documentation, and continuity of care.
Accuracy is key for ensuring you don’t run into snags and delays in reimbursement for your services. Staying up to date on the latest ICD-10-CM codes is important (they’re updated once per year.)
Having the right practice management system can also greatly streamline your use of codes and minimize errors through functionality like adding diagnosis codes to a client record, auto-populating diagnosis codes in notes, adding billing codes to services, and auto-populating diagnosis codes in Superbills and CMS-1500 forms.
Did you know Practice Better has a Superbills function that makes it super speedy to create a bill for you or your clients to submit to insurance? Take a demo to see all the ways that Practice Better can help streamline your systems and grow your practice.
Practice Better is the complete practice management platform for nutritionists, dietitians, and wellness professionals.
Practice Better is the complete practice management platform for nutritionists, dietitians, and wellness professionals. Streamline your practice and begin your 14-day free trial today.
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