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Dialysis billing

Michelle Posted Thu 25th of April, 2013 21:26:37 PM

What is the criteria for billing 90935 while patient is in the hospital? Does the Nephrologist have to be on-site or in the room in order to bill? Also, if my doctor sees the patient and then decides
he needs dialysis that day can the subsequent visit be billed with a 25 modifier?

SuperCoder Answered Mon 29th of April, 2013 04:58:42 AM

From Coding Alert :

Report Dialysis and Unrelated Admission Work

"When a chronic pediatric patient comes into the hospital, you have to change the way that you are coding," says Barbara Fivush, chief of pediatric nephrology at Johns Hopkins School of Medicine in Baltimore, Md., "and (pediatricians) do badly when we have to switch to the acute codes." It's not that the acute (or inpatient) dialysis codes (90935-90937) are so confusing, it's just that you may not know how to combine them with other E/M codes.

Pediatric coders lose a lot of reimbursement when they first admit (99221-99223, Initial hospital care, per day, for a patient ...) patients to the hospital, Fivush says. "You can bill for an admission on the same day that you bill for dialysis (90935-90937)," she says. "People don't know that, and they bill just for the dialysis or just for the admission - but you can get paid for both."

When billing for a same-day admit and dialysis, make sure to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code (99221-99223). The modifier indicates that you are reporting E/M services that are unrelated to the dialysis procedure.

90935 is medicine dialysis procedure where single evaluation can now be provided by Physician or other QHP rathar than just physician.

qualified healthcare professional(QHP)

Michelle Posted Mon 29th of April, 2013 19:35:32 PM

What is the criteria for billing inpatient Dialysis charges? Does the Nephrologist have to be in the hospital or in the room while the patient is having dialysis?

SuperCoder Answered Tue 30th of April, 2013 14:15:13 PM

When inpatient dialysis is necessary, the physician can be paid on a fee-for-service basis if the condition for which the recipient was hospitalized was not chronic renal disease. If the recipient was only hospitalized to receive maintenance dialysis (e.g., the only diagnosis on the claim is ESRD), the dialysis is considered an outpatient service and reimbursed under the MCP

Inpatient Billing/Non-CAP Payment
There are circumstances where inpatient dialysis is medically appropriate, and more intensive action/physician involvement is required.

• Use CPT codes 90935 - 90947 on the 837P claim format for dialysis sessions
• For inpatient dialysis, the physician must be physically present with the recipient at some time during the course of the dialysis procedure

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