title: Registered dietitians' coding practices and patterns of code use.
abstract: Coding, coverage, and reimbursement are vital to the clinical segment of our profession. The objective of this study was to assess understanding and use of the medical nutrition therapy (MNT) procedure codes. Its design was a targeted, cross-sectional, Internet survey. Participants were registered dietitians (RDs) preselected based on Medicare Part B provider status, randomly selected RDs from the American Dietetic Association database based on clinical practice designation, and self-selected RDs. Parameters assessed were knowledge and use of existing MNT and/or alternative procedure codes, barriers to code use/compensation, need for additional codes for existing/emerging services, and practice demographics. Results suggest that MNT is being reimbursed for a variety of diseases and conditions. Many RDs working in clinic settings are undereducated about code use of any kind, reporting that code selection frequently is determined not by the RD providing the service, but by "someone else." Self-employed RDs are less likely to rely on others to administrate paperwork required for reimbursement, including selection of procedure codes for billable nutrition services. Self-employed RDs are more likely to be reimbursed by private or commercial payers and RDs working in clinic settings are more likely to be reimbursed by Medicare; however, the proportion of Medicare providers in both groups is high. RDs must be knowledgeable and accountable for both the business and clinical side of their nutrition practices; using correct codes and following payers' claims processing policies and procedures. This survey and analysis is a first step in understanding the complex web of relationships between clinical practice, MNT code use, and reimbursement.
authors.affiliation: Department of Family Medicine, University of Tennessee, Knoxville, TN 37920-1511, USA. jwhite13@utk.edu <jwhite13@utk.edu>
authors.forename: Jane V
authors.initials: JV
authors.lastname: White
authors.forename: Keith T
authors.initials: KT
authors.lastname: Ayoob
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Benedict
authors.forename: Michele D
authors.initials: MD
authors.lastname: Chynoweth
authors.forename: Mary
authors.initials: M
authors.lastname: Gregoire
authors.forename: Robert L
authors.initials: RL
authors.lastname: Howard
authors.forename: Audrey
authors.initials: A
authors.lastname: McCool
authors.forename: Scott
authors.initials: S
authors.lastname: Parrott
authors.forename: Susan H
authors.initials: SH
authors.lastname: Ramsey
authors.forename: Charlotte
authors.initials: C
authors.lastname: Thiessen
authors.forename: Kim N
authors.initials: KN
authors.lastname: Thomsen
authors.forename: Tori
authors.initials: T
authors.lastname: Bender
authors.forename: Esther
authors.initials: E
authors.lastname: Myers
authors.forename: Pam
authors.initials: P
authors.lastname: Michael
mesh_terms: D003430:Cross-Sectional Studies; D004046:Dietetics / Q000191:economics / Q000592:standards*; D005568:Forms and Records Control; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data*; D020407:Internet; D016345:Medicare Part B; D044623:Nutrition Therapy / Q000191:economics / Q000592:standards*; D012051:Reimbursement Mechanisms; D014481:United States