Difference between Nutrition Education or Coaching & Medical Nutrition Therapy (MNT)-
Nutrition Education or Coaching
Definition: reinforcement of basic or essential nutrition-related knowledge.
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This valuable service educates patients about general health and wellness components, such as meal planning, food shopping, nutrient content, portion sizes, and label reading. This approach is less intensive.
What you can do that’s in scope: | What you can’t do that’s not in scope: |
· Provide general guidance and some structure around meals · Provide general education about nutrition and disease | · Prescribe a meal plan · Prescribe specific supplements and/or dosages · Treat disease with nutrition
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Who can provide this service:
A Certified Nutrition Specialist (CNS), Registered Dietitian (RD), Not-Credentialed Nutritionist, Fitness Trainer (e.g., NASM), Coach (e.g., NBC-HWC), and a few others can provide this with or without a license.
Might be able to file for insurance payout:
Often, it does not involve insurance reimbursement, which a practitioner must be credentialed with insurance networks to be able to do- some will be credentialed without a license. Still, some insurance companies will not (i.e., BCBS). If a practitioner is in an insurance network, it could fall under CPT Code 99401 (preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes; 99402 for 30 minutes, 99403 for 45 minutes or 99404 for 60 minutes. Also, there are specific ICD-10 codes that may be used for this service.
This can generally be provided in most states, but you need to know the laws for the state the client is in because each state has different rules about this and its telehealth or telemedicine laws, too.
***Remember, this is general education and guidance, so be careful in what you provide when providing nutrition education or coaching—know the state law where the client is and stay in your lane!
Medical Nutrition Therapy (MNT)
Definition: “Nutritional diagnostic, therapy, and counseling services for the purpose of disease management which are furnished by a registered dietitian or nutrition professional…” (source Medicare MNT legislation, 2000).
Registered dietitians or nutrition professionals are defined as follows:
``(A) holds a baccalaureate or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) with completion of the academic requirements of a program in nutrition or dietetics, as accredited by an appropriate national accreditation organization recognized by the Secretary for this purpose;
``(B) has completed at least 900 hours of supervised dietetics practice under the supervision of a registered dietitian or nutrition professional; and
``(C)(i) is licensed or certified as a dietitian or nutrition professional by the State in which the services are performed, or
``(ii) in the case of an individual in a State that does not provide for such licensure or certification, meets such other criteria as the Secretary establishes. (source Medicare MNT legislation, 2000).
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MNT involves in-depth, individualized nutrition assessment and intervention techniques such as medical history, physical examination, and dietary history to develop an appropriate plan, duration, and frequency of care using the Personal Nutrition Care Model to manage the disease. These plans could include avoiding or limiting certain foods, recommending a specific diet (i.e., gluten-free, low FODMAp, and therapeutic diets), ensuring the individual gets enough of a particular food or nutrient, recommending supplements and dosages, reviewing food/medication/supplementation interaction, and more.
Four components occur when providing MNT-
1. nutrition assessment and reassessment,
2. nutrition diagnosis and interpretation,
3. nutrition intervention and
4. nutrition monitoring and evaluation
Please note the process can look different depending on the individual needs. Medical conditions that someone could use this service for chronic kidney disease (CKD), Chronic Obstructive Pulmonary Disease (COPD), digestive conditions (i.e., celiac disease, Crohn’s disease, irritable bowel syndrome (IBS) and ulcerative colitis (UC), diabetes (Type 1, Type 2 and gestational or prediabetes), Heart failure, High Blood Pressure, Lipidemia, Malnutrition and more.
Who can provide this service:
MNT services should occur with a physician referral. Another component to be aware of is the state laws the client is in when services are rendered, but a Certified Nutrition Specialist (CNS) and Registered Dietitian (RD) can provide this service in most states.
This may include working directly with physicians, therapists, or other medical healthcare teams when providing MNT. The CNS or RD/RDN may monitor/work with the diet recommendations of one of the individual medical professionals or could be the one to make a diet recommendation based on a medical condition.
Might be able to file for insurance payout:
It depends on the practitioner whether insurance is available because the practitioner must be credentialed with each insurance company to file insurance claims. Still, a superbill can be provided if one is not credentialed to take insurance, which the individual can submit to their insurance company on their behalf.
If a practitioner is credentialed with an insurance network, the practitioner will document the claim with the MNT initial assessment, nutrition diagnosis, and intervention(s); plus, they can use physician diagnosis codes if a referral has been received. The following MNT CPT codes are:
97802 -MNT initial appointment.
97803-MNT follow-up appointment.
97804- MNT group appointment.
S9470-Dietitian Appointment.
Also, specific ICD-10 codes (e.g., Z71.3—dietary counseling and surveillance) may be used for this service.
This can generally be provided in most states, but you need to know the laws for the state the client is in because each state has different rules about this and its telehealth or telemedicine laws, too.
***Remember, this is intensive nutrition care, so be careful in what you provide when providing MNT—know the state law where the client is and stay in your lane!
References:
American Nutrition Association Website (n.d.) Retrieved from https://theana.org/ accessed 07/19/2024.
American Nutrition Association Website (n.d.) Retrieved from https://theana.org/code-of-ethics accessed 07/19/2024.
Bush, C. L., Blumberg, J. B., El-Sohemy, A., Minich, D. M., Ordovás, J. M., Reed, D. G., & Behm, V. A. Y. (2020). Toward the Definition of Personalized Nutrition: A Proposal by The American Nutrition Association. Journal of the American College of Nutrition, 39(1), 5–15. https://doi.org/10.1080/07315724.2019.1685332
U.S. Department of Health and Human Services. State Operations Manual, Appendix A – Survey Protocol, Regulations, and Interpretive Guidelines for Hospitals. Centers for Medicare and Medicaid Services. N.d. Updated February 21, 2020. Accessed December 1, 2020. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf
U.S. Department of Health and Human Services. Appendix PP – Guidance to Surveyors for Long Term Care Facilities. Centers for Medicare and Medicaid Services. N.d. Updated November 22, 2017. Accessed December 1, 2020. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf