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Dialysis Training and Pediatric ESRD related services

Virginia Posted Mon 06th of January, 2020 17:30:24 PM
Regarding Medi-Cal/CCS pediatric patients scenario: Pediatric patient starts PD home training 10/11/19. The nephrologist follows up with the patient on 11/10/19 but doesn't complete the training until 12/05/19. MD wants to bill an ESRD related service or E & M for November. If a pediatric patient is in training for home dialysis can we bill ESRD related services or an E & M during that time?
SuperCoder Answered Tue 07th of January, 2020 02:24:06 AM

Hi,

Thanks for your question.

 

Medicare pays for the training of patients to perform home hemodialysis, self-dialysis and the various forms of self-peritoneal dialysis. A standard training course consists of 25 training sessions. The course is billed when it is completed. Incomplete training course are payed per session.

 

Billing for completed dialysis training is done with the last training session date as the date of service. CPT code 90989 (dialysis training, patient, including helper where applicable, any mode, completed course) is used to identify the service performed. Box 19 on the HCFA 1500 form is used to indicate the training was completed. Incomplete training is billed with code 90993 (dialysis training, patient, including helper where applicable, any mode, course not completed, per training session) for each session. The number of completed sessions are indicated in the days or units field of the HCFA 1500 form.

 

The dialysis training fee is payment for reviewing a patients general living environment, counseling and/or training family members, training a dialysis patient or directing the training, and reviewing training progress. This fee also covers any ongoing services such as answering patient questions and offering more training on the original machine. Medicare may occasionally pay for additional training sessions if there has been a major change in the procedure. This additional training is only paid when a patient is switched to a new or untrained dialysis partner, or there is a change in the type of dialysis, or a change in equipment. Dialysis training would be billed with a place of service as the place the service was performed.

 

Therefore, if the home dialysis training is not completed then code 90993 should be billed.

Thanks.

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