# What is the correct way to bill 90935 & 99254



## CC5657 (Oct 16, 2007)

When a Nephroligist is requested to do an initial inpatient consult for an ESRD patient who was admitted to the hospital for *other reasons than renal & the patient will need to continue dialysis while in hospital, can the doctor bill 99254-25 & 90935??  This is the way our office has been billing and Medicare is only paying for the dialysis(90935). We read in the description that payment for all E&M services is bundled into the payment for 90935. Also in the description, it says that "these services may be reported as provided on the same date as a dialysis service, if the service is significant & separately identifiable, meets any medical necessity requirements & is reported with the use of modifier 25. 
Our doctors feel that they are doing a full initial consult along with managing the patients dialysis service.
Any help with this is much appreciated!!*


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## tamerasona (Jun 5, 2014)

I am having this same issue, and do not see any replies.  I have heard that you can actually bill the consult in this case as it has a higher RVU?


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## suebeecar (Jun 5, 2014)

tamerasona said:


> I am having this same issue, and do not see any replies.  I have heard that you can actually bill the consult in this case as it has a higher RVU?


Although it's 2014, I have this same issue. We normally bill 99222-25 with 90935, but this time it was denied because it was within the global period of a vascular procedure done the month before. So, my question is, would I just add modifier 24 after the 25 and change the diagnosis? Please help! I am so new at this and will take any help I can get with any Nephrology or vascular coding! Thanks...


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