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Thread: Nephrology (ESRD) Billing/Coding E/M Levels

  1. #1

    Question Nephrology (ESRD) Billing/Coding E/M Levels

    AAPC: Back to School
    Hi everyone,

    I am so confused. I just started working at this Nephrology Clinic doing coding and billing. PLEASE HELP! I'm going to give some scenario's and if someone can please tell if when to bill an initial vs. subsequent visit.

    Our dialysis clinic patient, another dr admitted, not ESRD related...

    Our dialysis patient, another dr admitted, ESRD related...

    I think I understand if it's our patient, we admitted, not ESRD related we can charge an INTIAL (99221,22, or 23) and if our patient, we admitted, ESRD related, we charge SUBSEQUENT(99231, 32, or 33).

    Thanks in advance!

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    If it is your patient and you are the admitting provider you use initial, no matter what the reason for the admit. If it is your patient and another dr admits then you charge subsequent for you first encounter with your patient as you are not consulting.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    Thanks soooooo much Debra, the person that was trying to explain it to me has been doing it for a long time and was talking completely over my head. I just became certified in March and this is the 1st job testing my skills and Wow

  4. #4

    Default esrd

    I disagree Medicare states and RPA if you are called by the PCP to perform a hospital consult you are allowed to bill for 99221-99223 this changed when the consult codes were terminated 2010.


  5. #5
    Join Date
    Apr 2007
    Columbia, MO


    If you are already treating the patient and are not the admitting provider and the admitting provider requests you to come and see your patient for the issues you have been treating then it is not initial, it is subsequent, since it is not a consult under old rules or new. If you are the admitting provider then it is initial level regardless of the reson for the admit. If you are not the admitting but are called in to see the patient for issues you have never addressed then this could be a consult and would be billed using the initial levels.
    BUT the question was if another doctor admits their dialysis patient for ESRD related issues, is this initial or subsequent -- I say subsequent, as this is not a consult.

    Debra A. Mitchell, MSPH, CPC-H

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