Michael Posted Tue 09th of May, 2017 11:02:47 AM
90935 - Applies to one hemodialysis treatment that includes a single physician or other qualified health care provider's evaluation of the patient. Does this face to face evaluation have to be done during the procedure in order to bill CMS? We were told that CMS had a policy that stated that the provider had to provide a face-to-face evaluation during the patient’s dialysis treatment and state this in their note or you could not bill the 90935.
The CPT states the following:
The dialysis–specialist physician performs Hemodialysis on the patient as per schedule and follows all prescribed parameters. During this procedure the blood is taken from the body and passed through special type of filter called a dialyzer where waste and extra fluids are removed and the clean filtered blood is returned to the body. Along with the procedure, the physician may also conduct an E/M service related to the dialysis procedure on the patient on the same day.
SuperCoder Answered Wed 10th of May, 2017 05:15:27 AM
The evaluation and management service will be done during the procedure and will be done face to face and E/M note should be included for the billed date of service. However, the evaluation and management service not related to dialysis procedure or renal failure will be eligible for separate reimbursement with modifier 25.
Along with the procedure, the physician may also conduct an E/M service related to the dialysis procedure on the patient on the same day but will not be eligible for separate reimbursement.
Hope this helps!
Michael Posted Wed 10th of May, 2017 13:16:13 PM
Just to clarify does the face to face evaluation have to be done during the procedure in order to bill CMS for the 90935?
SuperCoder Answered Thu 11th of May, 2017 01:45:43 AM
Yes, the evaluation and management will be carried out during the procedure.