Wiki Documentation Requirements for Inpatient Hemodialysis Services

[mauikidneydisease@mac.com]

Good afternoon,

I was hoping an AAPC member could offer some advice. My billing for inpatient services for hemodialysis treatment for a hospitalized patient with End Stage Renal Disease was denied by the insurance company because "the medical records submitted do not include hemodialysis evaluation from the servicing provider; therefore, the service cannot be verified." This is my first instance of denial of reimbursement for such services. Is anyone aware of formal documentation requirements for providing hemodialysis services in an inpatient setting?

Thanks,

Dr. H.

 

[mauikidneydisease@mac.com]

CPT Code 90935

I am updating my original post. The CPT code used for this service was 90935. Thanks.

 

[OCD_coder]

I am not finding anything formal, in the CPT Assistant publications, but "evaluation" to me means I would be looking for documentation similar to an E&M evaluation. The requirements are not outlined so I am thinking something similar to at least a detailed history, exam and moderate MDM. This would be in addition to the hemodialysis documentation needed to meet the code requirements.

I will keep looking for additional information for you.

 

[mauikidneydisease@mac.com]

Thanks for your help. Based on my research to date, a critical element is that the physician must document that he/she saw the patient during the hemodialysis treatment.