Parrott J Scott, White Jane V, Schofield Marsha, Hand Rosa K, Gregoire Mary B, Ayoob Keith T, Pavlinac Jessie, Lewis Jaime Lynn, Smith Karen
J Acad Nutr Diet. 2014 Oct;114(10):1619-1629.e5. doi: 10.1016/j.jand.2014.07.003.
Coding, coverage, and reimbursement for nutrition services are vital to the dietetics profession, particularly to registered dietitian nutritionists (RDNs) who provide clinical care. The objective of this study was to assess RDN understanding and use of the medical nutrition therapy (MNT) procedure codes in the delivery of nutrition services. Its design was an Internet survey of all RDNs listed in the Academy of Nutrition and Dietetics (Academy)/Commission on Dietetics Registration database as of September 2013 who resided in the United States and were not retired. Prior coding and coverage surveys provided a basis for survey development. Parameters assessed included knowledge and use of existing MNT and/or alternative procedure codes, barriers to code use, payer reimbursement patterns, complexity of the patient population served, time spent in the delivery of initial and subsequent care, and practice demographics and management. Results show that a majority of respondents were employed by another and provided outpatient MNT services on a part-time basis. MNT codes were used for the provision of individual services, with minimal use of the MNT codes for group services and subsequent care. The typical patient carries two or more diagnoses. The majority of RDNs uses internal billing departments and support staff in their practices. The payer mix is predominantly Medicare and private/commercial insurance. Managers and manager/providers were more likely than providers to carry malpractice insurance. Results point to the need for further education regarding the full spectrum of Current Procedural Terminology codes available for RDN use and the business side of ambulatory MNT practice, including the need to carry malpractice insurance. This survey is part of continuing Academy efforts to understand the complex web of relationships among clinical practice, coverage, MNT code use, and reimbursement so as to further support nutrition services codes revision and/or expansion.
营养服务的编码、覆盖范围和报销对饮食行业至关重要，对于提供临床护理的注册营养师（RDN）而言尤其如此。本研究的目的是评估RDN在提供营养服务时对医学营养治疗（MNT）程序编码的理解和使用情况。其设计为对截至2013年9月列于营养与饮食学会（学会）/饮食注册委员会数据库中、居住在美国且未退休的所有RDN进行的一项互联网调查。先前的编码和覆盖范围调查为调查开展提供了基础。评估的参数包括对现有MNT和/或替代程序编码的了解和使用情况、编码使用的障碍、支付方报销模式、所服务患者群体的复杂性、提供初始护理和后续护理所花费的时间，以及执业机构的人口统计学特征和管理情况。结果显示，大多数受访者受雇于其他机构，且兼职提供门诊MNT服务。MNT编码用于提供个人服务，用于团体服务和后续护理的MNT编码使用极少。典型患者患有两种或更多种诊断。大多数RDN在其执业机构中使用内部计费部门和支持人员。支付方组合主要是医疗保险和私人/商业保险。管理人员和管理/提供者比提供者更有可能购买医疗事故保险。结果表明，需要就RDN可用的当前程序术语编码的全范围以及门诊MNT执业的业务方面进行进一步教育，包括购买医疗事故保险的必要性。本次调查是学会持续努力的一部分，旨在了解临床实践、覆盖范围、MNT编码使用和报销之间复杂的关系网络，以便进一步支持营养服务编码的修订和/或扩展。
