I think Medicare picking up the tab for a defined number of visits would be a help to a practice that wants to start-up a new revenue center. I think the PCP who only sees obese patients periodically, and only when they arrive to the office for a Diabetes or HTN check would not necessarily gain the full advantage of the use of this G0447. I would advise my clients to consider creating a section of their practice designed specifically for obese patients.
Here is how I would proceed:
The HTN or Diabetic patient is seen in the office, either in follow up or initial. The patient’s BMI meets the 30 kg/m2 minimum requirement. Spend 15 minutes discussing the Intensive Behavioral Therapy (IBT) program (for which the provider would have established informational materials). I would bill Medicare for the appropriate E/M level of service that has been documented, and append a modifier -25. The dx code used for the office visit should agree with the chief complaint and/or findings (e.g. HTN, Diabetes). I would then bill HCPC code G0447 and use the diagnosis codes referred to in the Medicare bulletin dated 3/2012. The bulletin suggests Medicare may reimburse both codes when appropriate.
Note: The bulletin suggests a modifier 59 is payable, but that modifier is for procedures and not E/M codes. Note that each Medicare MAC may invent its own set of reimbursement rules, where one MAC pays, and other one does not.
I have seen a new tab, in the Medicare eligibility screen for patients, which indicates the number of visits used and available. So, Medicare will stop paying when the patient has met the number of visits allowed per year.
I do see a problem with starting an IBT program; the patient may be seen by any number of qualified providers, and each may submit the G0447 code for payment.
An example would be the female patient who is seen by her primary provider for HTN and is counseled in IBT and that provider submits a claim for G0447. Then, she sees her OB/GYN for her annual exam, and the GYN counsels her and submits G0447, then she sees her Internal Medicine doc in follow up for Thyroid, and is counseled in IBT and that providers submits a claim for G0447, thereby eliminating 3 of the 24 allowed visits per year. If the patient is in an IBT program with a practice, the patient should be told to let her other providers know this, in the hope that overuse of G0447 will not occur.
I see this code as useful for those practices that have a business plan to offer IBT as a part of an Obesity “clinic” or program. The description and use of the G0447 that I have, demonstrates that Medicare is looking for such a program as well. The patient has to meet certain milestones in order for the physician to continue using code G0447.
Having said all of that, if the practice agrees to establish a certain focus for obese patients (this would be great for those practices who know who their obese patients are….they should be able to run a report from their billing system to determine the number of patients with an obesity dx code), the next step would be to have a provider available to manage the IBT program. From what I have read, a NP or PA or Certified Clinical Nurse Specialist may provide the services.
The patients should be scheduled only for the IBT visit. If the patient needs to be seen for other clinical issues, they should be scheduled for another day. Of course, all of this is only for Medicare….non-government payors will have their own set of Preventive Care rules….