What is the correct way to bill 90935 & 99254


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When a Nephroligist is requested to do an initial inpatient consult for an ESRD patient who was admitted to the hospital for other reasons than renal & the patient will need to continue dialysis while in hospital, can the doctor bill 99254-25 & 90935?? This is the way our office has been billing and Medicare is only paying for the dialysis(90935). We read in the description that payment for all E&M services is bundled into the payment for 90935. Also in the description, it says that "these services may be reported as provided on the same date as a dialysis service, if the service is significant & separately identifiable, meets any medical necessity requirements & is reported with the use of modifier 25.
Our doctors feel that they are doing a full initial consult along with managing the patients dialysis service.
Any help with this is much appreciated!!


Local Chapter Officer
Holiday, FL
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I am having this same issue, and do not see any replies. I have heard that you can actually bill the consult in this case as it has a higher RVU?
Although it's 2014, I have this same issue. We normally bill 99222-25 with 90935, but this time it was denied because it was within the global period of a vascular procedure done the month before. So, my question is, would I just add modifier 24 after the 25 and change the diagnosis? Please help! I am so new at this and will take any help I can get with any Nephrology or vascular coding! Thanks...