- Diabetes Screening
- Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy?
- Diabetes Self-Management Training
- Diabetic Self-Management Tool for Billing
- DSMT: Documentation & Physician Order Requirements
- Common Questions for Diabetes Self-Management Training and Medical Nutrition Therapy
- Common Questions for Diabetes Self-Management Program Accreditation
- Medical Nutrition Therapy
- Medical Nutrition Therapy Tool for Billing
- Common Denials Guide for Diabetes Self-Management Training and Medical Nutrition Therapy
- Medicare Diabetes Prevention Program
DSMT: Documentation & Physician Order Requirements
Table of Contents
- DSMT: Documentation & Physician Order Requirements
- Documentation & Physician Order Requirements
- Provider Actions
- Related Content
DSMT: Documentation & Physician Order Requirements
NGS conducts prepayment reviews on claims for DSMT services for Part A for the following HCPCS codes:
- G0108: Diabetes outpatient self-management training services, individual, per 30 minutes
- G0109: Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
When responding to an ADR from Medical Review, it’s important to pay attention to the documentation that is being requested. Many claim denials have been issued for missing or incomplete documentation in the physicians order in response to an ADR. Based on these findings, we want to make those providers that render DSMT services aware of the documentation & physician order requirements.
Documentation & Physician Order Requirements
Before sending documentation in response to an ADR, be sure to check the documentation for the physician order to ensure all of the required elements are included. The physician order must include all the following:
- The number of initial/follow-up hours ordered
- Topics to be covered in the training and
- A determination that the beneficiary should receive individual or group training (including medical justification for individual versus group training)
In addition to the above, please ensure the following is included in the documentation:
- Documentation of the training session being rendered; individual/group.
- Documentation of time in, time out and/or the total time spent with the patient to support the number of units billed as G0108 and G0109 are timed codes.
Provider Actions
- Share this information with the appropriate departments who may be involved in ordering, providing, billing or reviewing medical records and documentation for these types of services
- Update any internal procedures or policies with the information in this article and in the associated referenced resources.