04/23/2019 - A change in coding requirements by Aetna requires more specific diagnosis codes for those submitting claims for member services (97802, 97803) using the diagnosis code Z71.3. The Academy has been in contact with Aetna and has learned the following:
- The December Aetna newsletter notified providers of a change in policy in regards to using code Z71.3 for "healthy diet counseling"
- The newsletter advised providers to "include an appropriate diagnosis when billing for dietary counseling," referring providers to Clinical Policy Bulletin 0049: Nutritional Counseling.
- Aetna does not consider the list of ICD-10 codes included in the bulletin an all-inclusive list. The key is that nutrition counseling must be "medically necessary" and "prescribed by a physician" for individuals with a chronic disease "in which dietary adjustment has a therapeutic role."
- The policy change was made based on medical record review in which most cases the documentation did not indicate a coverable diagnosis.
Claims that have been denied because of these recent changes can be resubmit claims with a more specific ICD-10 code if documentation supports such a diagnosis.