Wiki Documentation requirements for 90935/90937

alysenb

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Does anyone have a link or information on documentation requirements for 90935 or 90937. CMS doesn't really have anything. UHC is denying after reviewing medical records so I need to know what is missing and you know they won't tell me.
 
Hello Alysenb,:)
These 2 codes are related to the ESD of renal ds N18.6 hemodialysis process with single evaluation. If pt is getting outpt dialysis center too. Use dx Z99 last for supporting renal dialysis. Code CPT 90935 is used 1 time with differ Eva Mgt codes to evaluate by physician or other non phys HC personnel. Add modifier 25 to other CPT services such as outpt. visit, observation, EMR, nursing facility setting related to renal ds. See CPT manual yr 2023 pages 73. If a home visit should use the CPT code 99512. The UHC payer may want pre authorization when going to check the pt renal dialysis or maybe the pt. is getting care somewhere else on this same problem same time period or there is another payer. These maybe reasons for denial .
Well hope I helped you somewhat.
Lady T:)
 
What does the denial say? Going back to the Hemodialysis chapter guidelines in the CPT book can help. Then the description of each code. Also, there are CPT Assistant articles for these codes you can reference too.

You can try the CMS manuals: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c08.pdf

Older post but might help: https://www.aapc.com/blog/23304-fil...de,required during a hemodialysis procedure.”

Also old but might help:
Date Answered:04/06/2010
Please help us best document 90935, the seen on dialysis note. Can we simply sign the flow sheet, and write in the progress note that the flow sheet was reviewed and signed? Can we initial and comment on parts of the flow sheet, and link that to a small progress note? Keep in mind, the flow sheet has a tremendous amount of data on it. The key question is, do we have to re-copy that data to a progress note? The documentation of the 90935 must include a statement indicating the patient was seen on dialysis as well as the E&M service rendered on the day of dialysis.
 
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