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DOS conflict for Nephrology Code

  1. #1
    Default DOS conflict for Nephrology Code
    Medical Coding Books
    Hi All,
    I have a situation where a Dr. has legitimately charged 90960 for services provided during the month. This type of code is always charged on the last day of the month to account for all services provided during that month. In this particular case the pt passed away a few days prior to the end of the month, so the DOS appears to be after the death date despite the services actually being provided prior to death.
    Anyone seen this before? Any suggestions on how to resolve the problem so the services can be billed to ins?

  2. #2
    Kansas City, MO
    I think you should bill 90960 with the dos either as the date the pt passed or the day before. If it's denied, you can appeal because of the circumstances. The CPT description ("4 or more face-to-face visits ...per month) doesn't specifically say you absolutely have to bill it on the last day of the month. It's at least worth a try.
    Karen Cross, CPC, CPMA, CEMC, CUC

  3. #3
    Greetings! We use the date when the comprehensive monthly care plan was done, which is usually done at the beginning of the month. We bill a month in arrear. Hope this helps!

    Kendra Songer, CPC, CUC
    San Antonio Local Chapter
    President 2016
    Treasurer 2015

  4. #4
    Red face Guidelines
    Hi All,
    I do appreciate your help. Wanted to share what I found. The guidelines can be confusing sometimes, but what I have determined with help from coworkers is that the guidelines that apply in this situation are:

    If dialysis was stopped due to recovery or death, 90970 would be used to report each day outside the inpatient hospitalization. (pg 533 of the AMA pub of CPT for 2014)

    So for this occurrence I changed to 90970 for each dialysis treatment the pt had at the outpatient facility.


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