Monthly Capitated Payment for OP Dialysis

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Nephrologists are compensated for the outpatient renal-related care of dialysis patients via billing codes called the Monthly Capitated Payment. It is my understanding that there are two types, homebound dialysis and outpatient facility dialysis. Can anyone explain to me in regards to documenation for the weekly MCP visits to the patients, what is required in terms of documentation elements and if these visits need to be face to face.

I am still pretty green on this topic and trying to learn more. Any advice or guidance would be greatly appreciated.

Thank you,
 
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Monthly capitated payments for op dialysis

For Home Dialysis patients, the physician is required to see the patient 1 time per month. Home dialysis or PD is billed using 90966 for the monthly charge. Even if the patient changes modalities from HD to PD in the middle of the month, the physician will bill for a full month of PD.

In Center dialysis, or HD can be billed using 90962 (1 face to face visit with no MCP), 90961 (2-3 face to face visits with an MCP), or 90960 (4 face to face visits with an MCP) If the patient has been in the hospital, is a transient, or discontinued dialysis during the month, you will bill using 90970.

The exception to this would be if the patient had been seen the requisite number of face to face visits and had an MCP either before or after the hospitalization. In this case, you would use the appropriate monthly code. A hospital inpatient service can not be used as an MCP.

Hope this helps. You can find excellent information at rpa.renalmd.org .
 
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