# Inpatient Dialysis



## JenLawson (Jul 16, 2015)

Hi all,
I have a dilemma currently...
The doctor and coders are interpreting the same sentence in two diffierent ways. The sentence from CMS (https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r1776b3.pdf) reads:

"If both are billed, pay the dialysis service and deny the evaluation and management service."

This is in reference to 99233 Subsequent inpatient hospital, and 90935 hemodialysis, being billed for the same date of service.

Coder interpretation - bill only the hemodialysis 
Doctor intepretation - when both codes are submitted, bill the one the doctor wants billed. In this case 99233 should be billed because it has the higher RVUs.

Bear in mind that the NCCI lists 90935 as the column one code and 99233 as the column two code with a 0 modifier indicator. It is the case that 99233 has higher RVUs than 90935 does. Otherwise the documentation supports 99233 and meets the requirement of treatment for condition(s) other than ESRD.

B. Inpatient and Outpatient Dialysis Services On Same Date As An Evaluation and Management Service.--CPT codes 90935 and 90937 are used to report inpatient ESRD hemodialysis and outpatient hemodialysis performed on non-ESRD patients (e.g., patients in acute renal failure requiring a brief period of dialysis prior to recovery). CPT codes 90945 and 90947 are used to report all non-hemodialysis procedures. All four of these codes include payment for any evaluation and management services related to the patients renal disease that are provided on the same date as the dialysis service. Therefore, payment for all evaluation and management services is bundled into the payment for 90935, 90937, 90945, and 90947, except for the following evaluation and management services which may be reported on the same date as a dialysis service with the use of the --25 modifier and they are significant and separately identifiable and met any medical necessity requirements:
99201-99205 Office or Other Outpatient Visit for a New Patient
99211-99215 Office or Other Outpatient Visit for an Established Patient
99221-99223 Initial Hospital Care for a New or Established Patient
99238-99239 Hospital Discharge Day Management Services
99241-99245 Office or Other Outpatient Consultations, New or Established Patient
99251-99255 Initial Inpatient Consultations, New or Established Patient
99291-99292 Critical Care Services
In the absence of one of these codes being reported with the ?25 modifier and meeting the other requirements listed above, pay only the dialysis service and deny the evaluation and management service. Furthermore, payment is not allowed for more than one dialysis service per day.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1810B3.pdf

Please share your experiences and thoughts.
Thank you,
Jennifer


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## amsnead (Feb 1, 2016)

*answer*

I am curious if you ever found the answer to this question.  I am having the same issue with my Nephrology doctor.  



JenLawson said:


> Hi all,
> I have a dilemma currently...
> The doctor and coders are interpreting the same sentence in two diffierent ways. The sentence from CMS (https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r1776b3.pdf) reads:
> 
> ...


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## andreat.williams (Apr 21, 2016)

I have the same questions, too!!

Even those Medicare has IP guidelines, they sure do leave a lot open to interpretation...


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## maddismom (Apr 10, 2017)

*HD/Subsequent Hospital Visits*

They have to bill the HD. That's what the patient is being treated for and how. They can't bundle the HD into the room visit just because it pays more.


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