Question CKD Education Billing Code G0420-Nephrology Group

kguzikowski

Contributor
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Location
Muskego, Wisconsin
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When billing for service G0420 face to face service rendered can more than 3 sessions be billed by the same provider in an office setting on the same day and how should that be billed?
Example Patient seen by PA:
Example PA Bills as indicated below:
DATE OF SERVICE: 5-31-19
G0420
G0420
G0420
or must it be billed as G0420 x 3 units?

I understand each session must be face to face, per session, per hour, and billed for a stage four (4) CKD patient.
This is for a Nephrology Group.
 

kathrynw

Networker
Administrator
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Location
Grantsville, UT
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Hello,
I found this information under the clinical responsibility of G0420.
Clinical Responsibility
Kidney damage for three months or longer is considered chronic kidney disease. Education regarding the disease helps the patient to improve self care, autonomous decision making, better awareness of the disease, types of dialysis, and kidney transplantation. The education also helps the patient to manage the disease as well as the other related conditions along with it. The predialysis education helps to delay the need for dialysis. The provider renders this face to face educational service to an individual patient in a session of a minimum of 31 minutes up to one hour in length. The face to face session provided for the patient should be according to the referral of the treating provider. The provider, provider's assistant, or nurse practitioner at a hospital, home health agency, or comprehensive outpatient rehabilitation facility can provide this service. Report one unit of this code for each session per hour of the provider service.
Tips
You cannot report more than six sessions of kidney disease education to an individual patient in his lifetime.
When the provider gives face to face educational services related to the care of chronic kidney disease to a group, use G0421, Face to face educational services related to the care of chronic kidney disease; group, per session, per one hour.

This CMS article might also be of help.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM6557.pdf

Hope this helps,
 
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