Pathology/Lab Coding Alert

Why you can report only one ESRD G code

If you're choosing multiple codes from the G0308-G0319 series to describe treatment for end-stage renal disease (ESRD), then you can expect the denials to start rolling in.

That's because the National Correct Coding Initiative edits bundled G0308-G0319, which Medicare introduced this year. NCCI version 10.1 took effect April 1.

"The new NCCI edit pairs reflect the instructions given in the Nov. 7, 2003, Federal Register that document payment changes for physicians managing dialysis patients," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, president of Castillo Consulting in Manassas, Va.
 
Modifier Won't Override Edit Pairs

New codes G0308-G0319 describe monthly services for outpatient ESRD services based on the patient's age and the number of physician encounters per month. Codes G0320-G0323 describe the same monthly services for home dialysis patients. NCCI 10.1 says that each one of these codes G0308-G0323 is mutually exclusive with each other code -- resulting in the addition of 120 code pairs. Each pair shows a "0" modifier indicator, designating that you can never override the edit pair with a modifier.

The bottom line: "Even if the home dialysis patient receives a treatment in a dialysis center during the month, you should still report the appropriate G0320-G0323 code, and you should not additionally report a G0308-G0319 code. The fee schedule compensates the physician through the monthly capitation home code," Castillo says. The new NCCI edits enforce this coding restriction.

NCCI Limits Daily Home Dialysis with Monthly Codes

If the home dialysis patient becomes a hospital patient during the month, you should report one of the new codes G0324-G0327 (depending on patient age) for each day not in the hospital.

Hidden trap: "NCCI 10.1 confirms that you cannot report one of these daily codes with any one of the monthly codes," Castillo says. This restriction adds 60 more NCCI edit pairs to version 10.1, each with a "0" modifier indicator.

Know ESRD Code Parameters

The following table lists the 20 new ESRD G codes that Medicare bundled into 180 edit pairs in NCCI 10.1. The common portions of the code definitions are as follows:

The following table lists the 20 new ESRD G codes that Medicare bundled into 180 edit pairs in NCCI 10.1. The common portions of the code definitions are as follows:

G0308-G0319 -- End-stage renal disease (ESRD) related services during the course of treatment, for patients [insert range] years of age ...; with [insert number] face-to-face physician visits per month

G0320-G0323 -- End-stage renal disease (ESRD) related services for home dialysis patients per full month; for patients [insert range] years of age ...

G0324-G0327 -- End-stage renal disease (ESRD) related services for home dialysis (less than full month), per day; for patients [insert range] years of age ...