MNT vs. Education/Coaching

How Medical Nutrition Therapy (MNT) differs from Nutrition Coaching and Nutrition Education

One of the things dietitians worry most about when providing telehealth services is staying compliant with state dietitian laws. These state laws generally regulate who can use the title of dietitian or nutritionist or certified or licensed (in some combination).

Many dietitian laws exclude general nutrition education activities (aka “Nutrition related Health Coaching”) from their dietitian licensing requirement.

MNT

Privacy Requirements:

Requires HIPAA Compliant Platform, although Medicare has announced that it will temporarily waive these requirements due to Covid-19.

License Requirement:

Requires the purchase of a State License in Many States

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).

MNT is a specific application of the Nutrition Care Process in clinical settings that is focused on the management of diseases.

MNT involves in-depth individualized nutrition assessment and a duration and frequency of care using the Nutrition Care Process to manage disease.

Nutrition Counseling: A supportive process to set priorities, establish goals, and create individualized action plans which acknowledge and foster responsibility for self-care.

Referrals:

Provider sends RD written referral for MNT. The referral includes current labs, medications and diagnoses.

Nutrition Assessment:

RD performs the nutrition assessment utilizing the best available current knowledge & evidence, client data, medical record data etc.

Nutrition Diagnosis:

RD makes MNT nutrition diagnosis after analyzing assessment data.

Nutrition Intervention:

RD and client determine goals, care plan, and interventions; plan follow-up over multiple visits to assist with behavior/lifestyle changes relative to the nutrition problem and medical condition/disease(s)

Nutrition Monitoring & Evaluation:

Monitor serum albumin, hemoglobin, GFR, weight (BMI), goals for food plan/intake, clinical and behavioral outcomes.

Documentation:

RD documents MNT initial assessment, nutrition diagnosis and intervention(s); shares with physician and keeps copy on file.

CPT Code for Medical Nutrition Therapy

• 97802 -MNT initial appointment.
• 97803-MNT follow-up appointment.
• 97804- MNT group appointment.
• S9470-Dietitian Appointment.

Nutrition Education and Diet Coaching:

Platform:

Facetime & Skype are OK

License Requirement:

Unlicensed general diet education and food or nutrition “coaching” is probably legal in all states except Florida*.

Definition:

Reinforcement of basic or essential nutrition-related knowledge.

Referrals:

Interested individual self-refers or a medical provider refers.

Nutrition Assessment:

RD asks client his/her concerns/questions about the nutrition topic.

Nutrition Diagnosis:

RD determines the nutrition problem as the individual’s knowledge deficit on food choices or cooking techniques.

Nutrition Intervention:

Dietetics professional provides nutrition information with special emphasis on the individual’s identified needs.

Nutrition Monitoring & Evaluation:

RD checks if the individual’s needs are met, or selecting healthier foods.

Documentation:

RD sends a summary note to the physician or maintains documentation of the client’s visit outcomes data if self-referred.

Nutrition Education might be coded as:

CPT code 99401*: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes.  99402*: 30 minutes, 99403*: 45 minutes 99404*: 60 minutes

*To be used for persons without a specific illness.