Internal Medicine Coding Alert

Answer: Medicare pays for the training of patients to perform home hemodialysis, self-dialysis and the various forms of self-peritoneal dialysis, advises Cindy McMahan, CPC, an independent coding consultant based in Albany, Wis. A flat fee of $500 per patient is paid to a physician to train patients in self-dialysis. A standard training course consists of 25 training sessions. The course is billed when it is completed. Incomplete training course payment is $20 per session.

Billing for completed dialysis training is done with the last training session date as the date of service. CPT code 90989 (dialysis training, patient, including helper where applicable, any mode, completed course) is used to identify the service performed. Box 19 on the HCFA 1500 form is used to indicate the training was completed. Incomplete training is billed with code 90993 (dialysis training, patient, including helper where applicable, any mode, course not completed, per training session) for each session. The number of completed sessions are indicated in the days or units field of the HCFA 1500 form.

The dialysis training fee is payment for reviewing a patients general living environment, counseling and/or training family members, training a dialysis patient or directing the training, and reviewing training progress. This fee also covers any ongoing services such as answering patient questions and offering more training on the original machine. Medicare may occasionally pay for additional training sessions if there has been a major change in the procedure. This additional training is only paid when a patient is switched to a new or untrained dialysis partner, or there is a change in the type of dialysis, or a change in equipment. Dialysis training would be billed with a place of service as the place the service was performed. Most of the time the place of service would be the dialysis center.