Wiki HELP! Dialysis billing questions

[lethr77]

Dialysis: 90960 vs 90970

If a patient is seen at least once by the physician or NP in a limited capacity during dialysis Tx, but has not had a comprehensive assessment for the month does this still get billed under the 90960-2 if treated for the full month or would it be billed as 90970 x30days because the comprehensive is missing?
What if patient was only in for part of the monthly Tx, with limited face to face and no comprehensive and no record of hospitalization for said month (i.e. non-compliance with Treatment). Would this still be billed under 90970? If so, how would one determine the per diem? Simply go based on the number of times they appeared for treatment?
Am I thinking too much on this?

 

[rhh03]

Dialysis

We only use 90970 for our transient patients. If the patient is your regular patient and there was no comprehensive visit you should not bill for the month. You may want to see if the physician has enough information to where the basic visit that was done could possibly be enough for a comprehensive visit.

Using 90970 for an entire month on a regular dialysis patient could give red flags to payers. Which could cause an audit.

I hope that helps.

Renetta Houston-Hollingsworth, CPC