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Dialysis

Michael Posted Mon 21st of April, 2014 17:18:02 PM

If a patient over the age of 20 was seen for dialysis treatment at an outpatient location we would normally bill based on how many face-to-face visits were done by the doctor and if a complete assessment was completed. So if a patient has 2-3 face-to-face visits and a complete assessment was performed we would bill a 90961 for the entire month. My questions are as follows:

1. If a complete assessment was not done should we bill a 90970 in blocks or should we bill for the specific dates that the patient had treatment?

2. If the patient had 2-3 face-to-face visits and a complete assessment was done but the patent was then sent to the hospital for the last two weeks of the month what date should we put on the claim?

3. If the patient had 2-3 face-to-face visits and a complete assessment was done but the patent was then transferred to a different location or went on home dialysis and a different provider was monitoring this what date should we put on the claim?

4. If the patient had 2-3 face-to-face visits and a complete assessment was done but the patent was then transferred to a different provider would we still bill the 90961?

5. If the patient had 2-3 face-to-face visits and a complete assessment was done but the patent was then put on home dialysis under our care would we still bill the 90961 and the 90970 for each day the patient had home dialysis for the remainder of the month? Should we bill the 90970 in blocks or should we bill for the specific dates that the patient had home dialysis treatment?

SuperCoder Answered Tue 22nd of April, 2014 15:27:19 PM

1. Use 90970 to report each day of treatment outside Inpt. hospitalization. This is when Pt. did not receive "complete assessment".

Codes 90967-90970 are reported to distinguish age-specific services for end-stage renal disease (ESRD) services for less than a full month of service, per day, for services provided under the following circumstances: home dialysis patients less than a full month, transient patients, partial month where there was one or more face-to-face visits without the complete assessment, the patient was hospitalized before a complete assessment was furnished, dialysis was stopped due to recovery or death, or the patient received a kidney transplant. For reporting purposes, each month is considered 30 days.

Examples:

ESRD-related services:

ESRD-related services are initiated on July 1 for a 57-year-old male. On July 11, he is admitted to the hospital as an inpatient and is discharged on July 27. He has had a complete assessment and the physician or other qualified health care professional has performed two face-to-face visits prior to admission. Another face-to-face visit occurs after discharge during the month.

In this example, 90961 is reported for the three face-to-face outpatient visits. Report inpatient E/M services as appropriate. Dialysis procedures rendered during the hospitalization (July 11-27) should be reported as appropriate (90935-90937, 90945-90947).

If the patient did not have a complete assessment during the month or was a transient or dialysis was stopped due to recovery or death, 90970 would be used to report each day outside the inpatient hospitalization as described in the home dialysis example below.

ESRD-related services for the home dialysis patient:

Home ESRD-related services are initiated on July 1 for a 57-year-old male. On July 11, he is admitted to the hospital as an inpatient and is discharged on July 27.

In this example, 90970 should be reported for each day outside of the inpatient hospitalization (30 days/month less 17 days/hospitalization = 13 days). Report inpatient E/M services as appropriate. Dialysis procedures rendered during the hospitalization (July 11-27) should be reported as appropriate (90935-90937, 90945-90947).

SuperCoder Answered Tue 22nd of April, 2014 15:27:19 PM
With Apoorba
SuperCoder Answered Wed 23rd of April, 2014 04:41:08 AM

Replying to Amit to send this query to Leesa maybe. Am not able to resolve fully.

SuperCoder Answered Thu 24th of April, 2014 13:33:30 PM

.

Michael Posted Thu 24th of April, 2014 17:21:41 PM

Thanks but nothing in your post answered any of my specific questions. Could you possibly give me the specific answers to the questions that I posed below?

1. If a complete assessment was not done should we bill a 90970 in blocks or should we bill for the specific dates that the patient had treatment?

2. If the patient had 2-3 face-to-face visits and a complete assessment was done but the patent was then sent to the hospital for the last two weeks of the month what date should we put on the claim?

3. If the patient had 2-3 face-to-face visits and a complete assessment was done but the patent was then transferred to a different location or went on home dialysis and a different provider was monitoring this what date should we put on the claim?

4. If the patient had 2-3 face-to-face visits and a complete assessment was done but the patent was then transferred to a different provider would we still bill the 90961?

5. If the patient had 2-3 face-to-face visits and a complete assessment was done but the patent was then put on home dialysis under our care would we still bill the 90961 and the 90970 for each day the patient had home dialysis for the remainder of the month? Should we bill the 90970 in blocks or should we bill for the specific dates that the patient had home dialysis treatment?

SuperCoder Answered Wed 30th of April, 2014 09:23:35 AM

Answers :

1)Use 90970 to report each day of treatment outside Inpt. hospitalization. This is when Pt. did not receive "complete assessment".

2)90961 is reported for the 2-3 face-to-face outpatient visits. Report inpatient E/M services as appropriate. Dialysis procedures rendered during the hospitalization dates should be reported as appropriate (90935-90937, 90945-90947).

3)In this case, 90970 should be reported for each day outside of the inpatient hospitalization(home or different location). Report inpatient E/M services as appropriate. Dialysis procedures rendered during the hospitalization dates should be reported as appropriate (90935-90937, 90945-90947).

4)This is billed by one physician only. Other physician treating hospital inpatients (CPT-4 codes 99221 – 99233) are to be used.

5)The 90961 service does not include dialysis treatment. See 90935–90937 to report hemodialysis. As far as the other part is concerned it is best elaborated by this example :

Home ESRD-related services are initiated on July 1 for a 57-year-old male. On July 11, he is admitted to the hospital as an inpatient and is discharged on July 27.

In this example, 90970 should be reported for each day outside of the inpatient hospitalization (30 days/month less 17 days/hospitalization = 13 days). Report inpatient E/M services as appropriate. Dialysis procedures rendered during the hospitalization (July 11-27) should be reported as appropriate (90935-90937, 90945-90947).

I hope this helps now!

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