Pediatric Coding Alert

3 steps boost your nephrology dollars' Pediatricians who perform dialysis services aren't receiving the reimbursement they deserve when they admit their patients to the hospital. But with a few pediatric nephrology tips, you can improve your practice's pay. 1. Switch to 90923 for Per-Day ESRD Services From a coding and billing standpoint, pediatric nephrology is one of the most problematic subspecialties that there is, says Sandra Watkins, director of pediatric dialysis and co-director of the pediatric clinical research center at the University of Washington Medical School in Seattle. It can be especially difficult for primary care providers such as pediatricians who aren't used to the monthly capitated fees for dialysis services.
 
Although the monthly codes for outpatient end stage renal disease management (90918-90921), don't present problems to pediatric coders, pediatric dialysis patients are admitted to hospitals on a regular basis and that, Watkins says, is when pediatricians lose out on reimbursement.
 
You should report monthly codes such as 90918-90921 (End stage renal disease [ESRD] related services per full month ...) once per month only to describe full and consecutive months of service. So, if an 11-year-old patient begins outpatient ESRD related services on Nov. 1, but her pediatrician admits her to the hospital on Nov. 30, you shouldn't use 90919 (... for patients between two and eleven years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents).
 
For ESRD services lasting less than one month, you should switch to daily codes (90922-90925, End stage renal disease related services ... per day ...). For instance for outpatient services from Nov. 1-Nov. 29, you should report 90923 (... for patients between two and eleven years of age) 29 times - once for each day the pediatrician treated the patient as an outpatient. Even if pediatrician admits and discharges the patient on the same day (99234-99236, Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date ...), you shouldn't use the monthly ESRD codes.

2. Report Dialysis and Unrelated Admission Work "When a chronic pediatric patient comes into the hospital, you have to change the way that you are coding," says Barbara Fivush, chief of pediatric nephrology at Johns Hopkins School of Medicine in Baltimore, Md., "and (pediatricians) do badly when we have to switch to the acute codes." It's not that the acute (or inpatient) dialysis codes (90935-90937) are so confusing, it's just that you may not know how to combine them with other E/M codes.
 
Pediatric coders lose a lot of reimbursement when they [...]