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Home Dialysis Training - 90989 billing

Partners Posted Fri 03rd of March, 2017 09:34:39 AM
Billing for 90989 - Dialysis training, patient, including helper where applicable, any mode, completed course According to Medicare Claims Processing Manual Chapter 8 150 - Physician’s Self-Dialysis Training Services (Rev. 1, 10-01-03) Pay physicians for physician training services furnished to dialysis patients undergoing training by a flat fee of $500 (subject to the deductible and coinsurance requirements) for each patient under the physician’s supervision during the training course. Pay this upon completion of the training course in addition to the monthly capitation payment for physician’s maintenance dialysis services. If the training period is not completed, such as in instances where the patient can no longer be trained, prorate the training rate in proportion to the number of training treatments completed, but not to exceed $500. For purposes of this pro-ration, consider 25 training treatments as a complete course of training. Therefore, for an incomplete training course, pay the physician for the training services based on an amount of $20 per treatment times the number of treatments completed. This rule applies to all modes of treatment, including CAPD. However: This is a statutory x code which represent an item or service that is not in the statutory definition of "physician services" for fee schedule payment purposes. No RVUS or payment amounts are shown for these codes, and no payment may be made under the physician fee schedule. In addition, Medicare Benefit Policy Manual Chapter 11 30.1 - Home Dialysis Items and Services (Rev. 200, Issued: 12-02-14, Effective: 01-01-15, Implementation: 01-05-15)indicates: Effective January 1, 2011, payment for renal dialysis services furnished for home dialysis are covered under the ESRD PPS and are not separately paid. ESRD facilities shall not bill Medicare beneficiaries directly when they furnish renal dialysis items and services included under the ESRD PPS. It appears the information is contradicatory. Is the payment to the physician ($500) still in effect? With this code being a statutory x and as indicated above (Medicare Chapter 11), would the dialysis training be covered under the ESRD PPS and not separately reimbursed? Any feedback is greatly appreciated. Thank you
SuperCoder Answered Mon 06th of March, 2017 03:34:14 AM

Hi,

There is no hard and fast number on any CMS documents. The code itself does not specify what modality the training is for. There are some that will tell you that it must be 25, but there is NO basis for that number.

The methodology for billing 90993 is reported by the Medicare contractor, Trailblazer, (and others, but I am quoting them specifically) as "Only for purposes of pro-ration, Medicare will consider 25 training treatments as a complete course of training" .This number is used because the Medicare regulations stipulate that the incomplete training cannot exceed $500, and they have assigned the 90993 at $20 per day. If you do some real digging, you will see that CMS in different publications and manuals identify that there are different "normal" training periods for each modality, Hemo, CCPD, CAPD etc, but still only one code.

 

As per Medicare, “90989 – Dialysis training, any mode, course completed”-
1. Need to be billed with place of service 65 (End-Stage Renal Disease Treatment Facility - A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis) on a professional claim.
2. The facility should be certified by Medicare.
3. The date of service should be the date when training is completed.
4. It can be billed only once per patient.
5. All people with Medicare with ESRD are covered.

Medicare Part B covers training if you're a candidate for home dialysis, as well as training conducted during the course of your regular treatments for you and the person helping you with your home dialysis treatments. The training must be conducted by a dialysis facility that has been certified by Medicare to provide home dialysis training. Only dialysis facilities can bill Medicare (directly or under arrangement) for providing home dialysis training. Please feel free to ask for any further query. Thank you.

Partners Posted Mon 06th of March, 2017 12:17:24 PM
Where can I locate the document with the "as per Medicare" information, specifically, 1. Need to be billed with place of service 65 (End-Stage Renal Disease Treatment Facility - A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis) on a professional claim. Please provide the link. I am unable to locate this. Thank you
SuperCoder Answered Tue 07th of March, 2017 06:00:50 AM
Partners Posted Tue 07th of March, 2017 08:44:56 AM
Thank you for the link. This does not provide the reference that it applies to code 90989. It only provides a general place of service description. Please assist in finding the document which contains the information listed: As per Medicare, “90989 – Dialysis training, any mode, course completed”- 1. Need to be billed with place of service 65 (End-Stage Renal Disease Treatment Facility - A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis) on a professional claim. 2. The facility should be certified by Medicare. 3. The date of service should be the date when training is completed. 4. It can be billed only once per patient. 5. All people with Medicare with ESRD are covered. Thank you
SuperCoder Answered Fri 10th of March, 2017 02:59:44 AM

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