Nephrology and hospital care

A doc asked today: I am a nephrologist and manage patient's dialysis. I am also a primary care doc and will manage the non-kidney related illnesses. If I admit a patient for a pneumonia, I bill for the hospital care for the pneumonia and for managing their dialysis but have been denied. Can I get paid for both? How do I code this?

nephrologist/pc doc

You can list the the dx for pneumonia and additional dx relating to the managing of the dialysis, but you can only submit one E&M code for the admission. The same applies to hospital subsequent care. Treating both issues may require a higher level of care, but does not allow for additional billing.

Is there a special code

to report management of dialysis that is not an E&M, like the code for management of ventilator?

yes

90935,
90937

nephrologist

For physicians to receive payments based on inpatient dialysis procedure codes, the MCM requires:
< The place of service to be at an inpatient hospital [MCM '15062.1.D],
< The medical record must document that the physician was physically present with the patient at some time during the course of the dialysis [MCM '15062.1.C.2], and
< The medical record must document that the physician’s repeated evaluation of patients during the hemodialysis procedure was medically necessary [MCM '15062.1.A.1 and 15062.1.C.1].
physicians may bill inpatient dialysis procedure codes only if they visit the patient during the dialysis treatment and the medical record documents this.” In addition, the Carrier informed physicians of the medical necessity requirement by stating, “…multiple visits on the same day must be documented to indicate the visits were at different times and were medically necessary.” [Emphasis Added.]

The CCI edits bundles 99231-99233 into the inpatient dialysis services and the indicator is 0, no modifier will bypass this edit. The dialysis will be only service paid.

nephrology

The hospital admission codes are bundled into the inpatient dialysis service but codes 99221-99223 have an indicator of "1". Bill the admit code with -25 and the pneumonia diagnosis; then also bill the inpatient dialysis code as long as criteria is met and documented, with the ESRD diagnosis code. The E/M level should only reflect the work performed for the pneumonia diagnosis.

nephrologist/hospital charges

Can you tell me whether this information is still current? I sent this to one of our coders and she thinks a subsequent visit can be billed with the 90935 or 90937 and paid with a modifier.

Nephrology

Subsequents will never be paid with 90935,37,90945,47. These codes will only be paid with an inital, consult or discharge. A -25 modifier will still need to be added to those codes.

nephrology and hospital visits

Thanks, I just wanted other confirmation because I was not being believed - because if it is not on the list of CCI edits, then the billing office thinks they are correct.