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dialysis daily code vs. montly code

  1. Default dialysis daily code vs. montly code
    Medical Coding Books
    Medicare has denied payment for the daily code (90935) because the patient had a monthly code in the same month. The daily code is billed as an outpatient charge due to patient is in our facility as an OBV's patient stay. The patient is ESRD and has a chronic home facility which billed the montly code.
    An appeal went to Medicare with the 90970 cpt code which was also denied due to the daily code and monthly code cannot be billed during the same month. How do we bill the procedure so it is paid?

  2. Default
    Per CPT guidelines, 90935 is only billable in an IP setting if the pt is ESRD. For observation services, your physician would only bill the applicable e/m code.
    Lisa S.

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