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S9470 - Nutritional Assessment - DOC

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					ACCESS ALLIANCE OF MICHIGAN, 2-1-00
                             NUTRITIONAL ASSESSMENT

Covered Service
Nutritional Assessment – These are activities provided by a registered dietitian to determine a
beneficiary’s need for services and to recommend a course of treatment. The Nutritional Assessment
shall include a written summary of beneficiary background, physical, clinical, diet information and
applicable ICD-9 diagnostic code. Based on assessment findings, a recommended course of treatment
will be included in the document.

Current AAM Procedure Code                                       Unit Type (Current)
       Nutritional Assessment – S9470                                   Encounter


Eligibility Criteria and Service Priorities:

1.       Beneficiary is experiencing a mental illness, emotional disorder or developmental disability,
         reflected in a primary, validated or provisional, DSM IV or ICD-9 Diagnosis (not including V
         Codes).

2.       If applicable, the consumer, advocate or guardian has pursued authorization for this service from
         their qualified health plan or commercial insurance and has received a notice of denial of
         coverage.

3.       At least one of the following is present:

         A.        Person has experienced recent appetite change with significant weight gain/loss or other
                   evidence of nutritional compromise
         B.        Person has a diagnosed serious physical condition such as diabetes, kidney disease, liver
                   disease, gastrointestinal disease, cancer or other neurological/psychogenic compromise
                   that would benefit from assistance with diet modifications
         C.        Person presents ongoing problems with chewing, swallowing, nausea, vomiting, diarrhea
                   or constipation
         D.        Person requires assistance following a modified diet (texture) or management of a
                   feeding tube
         E.        Person has a diagnosed food allergy(s) or intolerance
         F.        Person is currently prescribed medication for psychiatric purposes by a CMH Board
                   employed or contracted physician and as a result may require a specialized diet to
                   prevent adverse physical response due to food/medication interactions, e.g. MAOI
                   medications.

4.       The beneficiary , advocate or guardian has an expressed outcome related to community
         integration, volunteering, employment or maintenance of health and safety.

Associated Outcomes
       Development of a plan that identifies interventions:
       A.     To improve the health and/or safety of the consumer through proper nutrition/hydration.
       B.     And/or coordination of diet with concurrent medical conditions and/or medications.

Typical Service Utilization Pattern
Any beneficiary receiving services is eligible for at least one (1) Nutritional Assessment per year; another nutritional
assessment for the new treatment year may be requested as early as two months prior to the Person Centered
Planning Meeting to assist in treatment planning and preparation. Additional assessments may be authorized should
there be a substantial change in the beneficiaries clinically related, discipline appropriate presentation.

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