Outpatient dialysis brings coding challenges

December 9th, 2015

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains the main coding considerations for outpatient dialysis services, including diagnosis reporting, hemodialysis, home-based services, other renal replacement therapies, and monthly end-stage renal disease billing. It is aimed at coders and billing professionals who need a broad overview of the ICD-10-CM, CPT, and Category II code sets used in dialysis-related reporting. The discussion focuses on when different code families are used and how dialysis-related services are organized for reporting purposes.

Why This Topic Matters

Dialysis claims involve multiple code sets and reporting scenarios, so understanding the scope of dialysis coding helps reduce missed or inconsistent reporting. The article is relevant for organizations that bill ESRD and outpatient renal replacement services.

Article Sections

  1. Reporting diagnoses

    Covers the diagnosis reporting framework for end-stage renal disease and related underlying conditions. Also addresses dialysis patient status reporting.

  2. Hemodialysis

    Introduces hemodialysis as a service category and discusses related procedural reporting topics. Includes physician evaluation patterns, home-based service contexts, access-related reporting, and flow study concepts.

  3. Other renal therapies

    Summarizes non-hemodialysis renal replacement therapy categories and the associated home-service reporting context. Also addresses service duration considerations.

  4. ESRD

    Describes monthly reporting for ESRD dialysis services and the general factors used to organize the reporting structure. Also notes partial-month service reporting and related evaluation services.

What You Will Learn

  • How the article frames diagnosis reporting for dialysis patients
  • Which broad dialysis service categories are discussed
  • How outpatient and home dialysis topics are organized in the article
  • How monthly ESRD reporting is structured at a high level
  • What types of dialysis-related service settings are covered

Who Should Read This

  • Medical coders
  • Billing specialists
  • Revenue cycle staff
  • Nephrology practice staff
  • Outpatient facility coding teams

Codes Discussed

  • ICD-10-CM: N18.6
  • ICD-10-CM: E10.22
  • ICD-10-CM: E11.22
  • ICD-10-CM: I12.0
  • ICD-10-CM: I13.11
  • ICD-10-CM: Z99.2
  • CPT: 36147
  • CPT: 90935
  • CPT: 90937
  • CPT: 99512
  • Category II: 4052F
  • Category II: 4053F
  • Category II: 4054F
  • CPT: 90940
  • CPT: 93990
  • CPT: 90945
  • CPT: 90947
  • HCPCS Level II: 99601
  • HCPCS Level II: 99602

Code Ranges Discussed

  • CPT: 90951-90966
  • CPT: 90967–90970

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