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What must intensive behavioral counseling for obesity include to be reimbursed by Medicare? Find out the answer to this pressing coding question.
Q: I heard there is a new code to help counsel patients regarding their obesity. Can you give me details? What do I need to do to bill it?
G0447 is for 15 minutes of face-to-face behavioral counseling for obesity. This code is effective for claims submitted after November 29, 2011, for patients with obesity, which is defined as a body mass index (BMI) greater than or equal to 30 kg/m2.
At the 6-month visit, perform a reassessment of obesity and determine the amount of weight loss, and document this information in the patient's chart. Patients must have a reduction of at least 3 kg (6.6 pounds) in the first 6 months of intensive therapy to be eligible for the face-to-face visits during months 7 to 12.
Effective July 2, Medicare will pay for G0447 (with correct diagnosis code) no more than 22 times in a 12-month period. Keep in mind that Medicare will allow for a professional and facility when applying this frequency limitation.
IBT for obesity should include:
Also, IBT should be consistent with the 5-A framework, which is:
1. Assess. Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
2. Advise. Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
3. Agree. Collaboratively select appropriate treatment goals and methods based on the patient's interest in, and willingness to change, the behavior.
4. Assist. Use behavior change techniques (self-help and/or counseling) to help the patient achieve agreed-on goals by acquiring the skills, confidence, and social/environmental supports for behavior change, adding adjunctive medical treatments when appropriate.
5. Arrange. Schedule follow-up contacts (in person or by phone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.
The author is a medical consultant based in Indianapolis, Indiana. Do you have a primary care-related coding question you would like to have our experts answer in this column? Send it, along with your feedback, to firstname.lastname@example.org