Bariatric Times

Insights into Patient Pop with Obesity 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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C18 Bariatric Times • December 2016 • Supplement C R eimbursement is available from Medicare for intensive behavioral therapy (IBT) for obesity, 44 as obesity is a disease and should be treated as such. In the event that obesity cannot be treated or reimbursed as a disease, it may be possible to treat the obesity-associated comorbid conditions, using E&M codes. Medicare Part B allows for reimbursement for IBT for obesity with certain restrictions. Reimbursement may be available for screening for obesity in adults (using the body mass index [BMI]), dietary or nutritional assessments, intensive behavioral counseling, and therapy, aimed at promoting and sustaining that weight loss through high-intensity interventions on diet and exercise. It is advantageous here that the Medicare coinsurance and Part B deductibles are waived. Private insurance coverage for IBT for obesity have not been standardized, so it is difficult to make general statements. Some private insurance covers IBT for obesity, some does not. However, Medicare policy exerts a major influence on the commercial healthcare insurance system which often adopt or reflect the reimbursement and coverage policies of Medicare. With Medicare offering reimbursement for IBT for obesity, it can be hoped that more universal private insurance coverage will soon follow and become standardized. The requirements for Medicare coverage for IBT for obesity are described in Table 4. Weight loss must be at least 3kg (6.6 pounds) in first six months, which represents a modest and reasonably attainable goal. At present, no specialists (e.g., cardiologists or endocrinologists) are reimbursed for IBT for obesity. Reimbursement covers up to 22 IBT session per year. Healthcare practitioners administering IBT must provide adequate documentation of IBT for obesity. Medical records must document all of the coverage requirements, including the determination of weight loss at the six-month visit (to assure continuing coverage). Documentation should be consistent with the so-called 5-A approach, described in Table 5. IBT for obesity is a stand-alone benefit, that is, it is a billable service which is separate from the initial preventive physical exam (IPPE) or the patient's Annual Wellness Visit (AMV). Medicare beneficiaries may obtain IBT for obesity services at any time after they enroll in Medicare Part B, including during their IPPE or AMV encounter. Note that obesity counseling is not separately payable with another visit on the same day with the exception of initial physical examinations, diabetes self- management, and medical nutrition therapy services (code 77X) and distinct procedural service claims (modifier 59). 44 When submitting professional claims, report the appropriate Healthcare Common Procedure Coding System (HCPCS) code and the corresponding ICD-10- CM diagnosis code in the X12-837-P (professional) electronic claim format. Include the place-of-service (POS) codes to indicate where service was provided. The Administrative Simplification Compliance Act (ASCA) requires providers to submit claims electronically to Medicare (with certain limited exceptions). Institutional claims, on the other hand, should report the revenue code when reporting the appropriate Healthcare Common Procedure Coding Insights into the Patient Population with Obesity: Assessment and Treatment navigating the billing system Christopher D. Still, DO, FACN, FACP Medical Director, Center for Nutrition and Weight Management; Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania

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