Wiki Dialysis vs Subseq. Hospital care

[mosmith]

Hello everyone. I have a question that I despirately need help with. The nephrologist is seeing a medicaid patient in the hospital daily and 3 of those days are dialysis treatment visits. Medicaid doesn't cover dialysis code 90935. Is it okay if I bill a subsequent hospital visit code 99231-99233 as appropriate instead of the dialysis code? Would the doctors visit to see the patient while on dialysis be considered suqsequent visit also? Please help!

 

[dsh1951]

Documentation is the key

Are you certain Medicaid doesn't pay 90935? Since that is an inpatient service, I would check with your Medicaid ombudsman to see why it isn't covered and if your state has a different code it requires for the service. In regard to charging subsequent visits for the dialysis days, that will depend on the documentation done by the physician. Some nephrologists only document that they saw the pt and general remarks regarding the HD when they see the pt on dialysis which do not meet the requirements of a subsequent visit. Others document the 2 out of 3 elements required for an e/m, in which case you could bill the subsequent visit.