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ESRD Coding

skon5

New
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Saint Paul , MN
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Need help with an ESRD coding question.

For ESRD Services, age 20 or older.

If the patient was seen for 3 FTF visits (example dates: 12/1, 12/4, 12/7) and had a complete assessment done (example date: 12/15). What is the correct code to bill – 90960 or 90961?

In reading CPT, one of the examples infer coding 90961, but some have said that the complete assessment (because it’s a FTF visit) counts as a visit date too, thus coding 90960 is correct.

I haven’t been able to located a resource to support one way or the other. Help is appreciated. Thank you!
 

jsalzer50

Networker
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Vancouver, WA
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ESRD codes

Hello!

Based on the example I read in the CPT manual, I would go with 90961.

"He has had a complete assessment and the physician or other qualified health care professional has performed two face-to-face visits prior to admission. Another face-to-face occurs after discharge during the month. In this example, 90961 is reported for the three face-to-face outpatient visits." (CPT 2016, page 588)

It seems the CPT manual is a good resource to go by. Based on the manual, it looks like a complete assessment isn't counted as a face-to-face visit, (even though it seems like it would!).

- Jacob
 
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