confusion with ESRD

metzger130

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We have a patient that the doctor goes to a dialysis facility 4 times a month to see the patient and for the dialysis. We do a 90960 for this as it is 4 or more face to face per month. the doctor also saw the patient in the office the same month for the ckd, but also for diabetes, hypertension, and vitamin D deficiency. Is this a billable office visit? When I see 4 or more face to face visits, to me that is 4 or more visits for dialysis, as that is what the code is for, but does that include all office visits also?

thank you,
Rob
 

Jennifer Turner

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Local Chapter Officer
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Indianapolis, IN
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Hi Rob,

I am in a Nephrology practice and we bill for MCP services as well... To simplify things, anything that is Outpatient (home, office, or ED) will not be billed separately and will be included in the MCP count. Although the pt. have Diabetes and Hypertension they are very highly likely the underlying condition of the Kidney disease. The only way that we are able to bill separately and get paid is if, the reason for the visit is NOT related.

Also, please note that if the Dr. see pt. in the office and the pt only has 3 MCP visits (must have at least one face to face) for the month, since that office visit is considered Outpatient you may apply that toward MCP to make it 4 visits for the month.

Hopes this helps!
 
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