Wiki Dialysis

[suec]

Have a scenario, patient had their AV fistula declotted in the hospital as outpatient service and then went to dialysis in the hospital. Coded 36905 & 93935. Does anyone know what modifier is needed on CPT 93935? This is a Medicare Managed care plan. Tried V7 but the claim is not being billed separately. Any suggestions?

 

[Deborah Marsh]

Hi - Was the dialysis inpatient? If so, perhaps there's something helpful on the inpatient forum.

 

[suec]

Thank you but it was done as outpatient,

 

[Deborah Marsh]

In case it helps, I'm assuming the code is 90935 (not 93935), and outpatient Medicare NCCI has a 90935/36905 edit with 36905 in the col. 2 position (can override the edit with an NCCI modifier, when appropriate).

 

[thomas7331]

Have a scenario, patient had their AV fistula declotted in the hospital as outpatient service and then went to dialysis in the hospital. Coded 36905 & 93935. Does anyone know what modifier is needed on CPT 93935? This is a Medicare Managed care plan. Tried V7 but the claim is not being billed separately. Any suggestions?

Are you billing for the physician or hospital? Most likely this is a different physician of a different specialty performing the intervention from the one supervising the dialysis, so it would be two different professional claims and no modifier needed on the MD side. In that case, for the hospital claim then could apply a modifier XP to override the edit.