Wiki nephrology & dialysis

[Sandra F]

I need help with monthly dialysis chgs (MCP) and hospital charges.
Pt is in the hospital Oct 15 - 20. Our physicians provide follow up visits and dialysis while in the hospital. We are also billing a full month of maint dialysis
(90960). Would I bill 90970 for 10/1/- 10/14 and 10/20 - 10/30? Can I bill a full month of maint dialysis in addition to the hospital charges? Is there any documentation for this scenario? Thank you.

 

[pjohnson@springfieldnephrology.com]

For Home Dialysis patients, the physician is required to see the patient 1 time per month. Home dialysis or PD is billed using 90966 for the monthly charge. Even if the patient changes modalities from HD to PD in the middle of the month, the physician will bill for a full month of PD.

In Center dialysis, or HD can be billed using 90962 (1 face to face visit with no MCP), 90961 (2-3 face to face visits with an MCP), or 90960 (4 face to face visits with an MCP) If the patient has been in the hospital, is a transient, or discontinued dialysis during the month, you will bill using 90970.

The exception to this would be if the patient had been seen the requisite number of face to face visits and had an MCP either before or after the hospitalization. In this case, you would use the appropriate monthly code. A hospital inpatient service can not be used as an MCP. You can only bill the 90960 if the patient has had the 4 face to face visits (in an outpatient facility) and one of those visits is the MCP.

Hope this helps. You can find excellent information at rpa.renalmd.org .

 

[JEYCPC]

The exception to this would be if the patient had been seen the requisite number of face to face visits and had an MCP either before or after the hospitalization. In this case, you would use the appropriate monthly code. A hospital inpatient service can not be used as an MCP. You can only bill the 90960 if the patient has had the 4 face to face visits (in an outpatient facility) and one of those visits is the MCP.

If you bill for inpt visits, can you still use the 90960 if they saw the patient in the dialysis unit (for the corresponding amount of visits?)too?

For transient patients how do you bill 90970? For the time they are visiting our area? or use 1 unit per treatment?