ESRD coding question


Bastrop, TX
Best answers
In Nephrology our providers see patients who are on home dialysis in the dialysis center once for a monthly face to face visit and labs.....
We are currently billing with CPT code 90963 based on pts age, billing under facility POS (63). This is what the providers have been told to use prior to me supporting the department...
These codes apply to all ESRD-related physician services provided during a one-month period to home dialysis patients of specified ages. These codes include establishing the dialyzing cycle as well as physician evaluation and management related to the ESRD. Codes 90963-90965 also include assessment of the patient's nutritional status, growth and development, and provision of parental counseling. Code assignment is based on age. Report 90963 for patients younger than 2 years of age, 90964 for patients 2 to 11 years of age, 90965 for patients 12 to 19 years of age, and 90966 for patients over the age of 20.
We are getting quite a few denials for POS being incorrect... I am not finding any information that supports this...Any information would be greatly appreciated...
For our PD pts, we have a dummy code that we use for the actual date that they patient is seen in the dialysis center for their FTF visit just for tracking purposes. There is actually no charge going to the insurance company as it is included in the Global ESRD maintenance codes. All dialysis, whether pd or hd, should be billed out on the 1st of the following month (so pd visit in February would be billed as date of service 3/1/2021 for all pd patients) with the dialysis center as the POS-65! Make sure you only use code N18.6 and no other codes. You are likely getting denied because of the POS and because the ftf is included in the monthly maintenance.