Nutrition counseling in the physician's office: how do I bill for advising my patient?

In addition to diagnosing and treating illnesses, physicians often provide nutrition counseling services. Billing and obtaining appropriate reimbursement for these services present a unique challenge. This article utilizes 4 hypothetical scenarios as a basis for examining common categories of service that involve nutrition counseling. These categories are: routine physicals that include nutrition counseling, nutrition counseling alone, nutrition counseling as a small part of a problem-oriented "evaluation and management" (E/M) service, and nutrition counseling as the bulk of a problem-oriented E/M service. The basics of procedure (CPT) and diagnosis (ICD-9) coding are described, and specific billing instructions for each scenario are provided. Although this article provides an introduction to the topic of billing, healthcare providers and their office staff should inform themselves on general coding and billing practices, as well as local payors' guidelines.