By Debrarose Toscano, CPC, PCS, CPC-I
Dialysis is necessary treatment for cleansing the blood when a patient’s body can no longer perform the function on its own. For some patients, dialysis treatment may be temporary (patient with ARF - acute renal failure), or permanent (patient has ESRD or waiting for a kidney transplant). Two types of dialysis treatment are hemodialysis and peritoneal dialysis.
Hemodialysis involves transferring a patient’s blood and waste products to the outside of the body, where they are filtered and then returned to the body after cleansing. CPT® codes 90935 and 90937 are submitted according to the number of times the physician evaluates the patient during the hemodialysis session. Here are some of the codes applicable to hemodialysis:
- 90935*—Hemodialysis procedure with single physician evaluation
- 90937*—Hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription
- 90940—Hemodialysis access flow study to determine blood flow in grafts and arteriovenous fistulae by an indicator method
- 99512—Home visit hemodialysis
- 36831, 36833, 36860, 36861—Cannula declotting
- 36593—Declotting by thrombolytic agent of implanted vascular access device or catheter
- 36591—Collection of blood specimen from a completely implantable venous access device
- 99354-99360—Prolonged physician attendance
- 93990—Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow)
Peritoneal dialysis treatment is when the physician filters the patient’s blood in the peritoneal cavity. In order for cleansing to take place, dialysis fluid is left in the cavity for several hours before it is drained. CPT® codes 90945 and 90947 are reported daily according to the service provided by the physician. Some peritoneal codes include the following:
- 90945*—Dialysis other than hemodialysis (e.g., peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single physician evaluation
- 90947*—Dialysis other than Hemodialysis (e.g., peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies) requiring repeated physician evaluations, with or without substantial revision of dialysis prescription
- 49420, 49421—Insertion of intraperitoneal cannula or catheter
- 99601, 99602—Home infusion of peritoneal dialysis
* These CPT codes incorporate the professional services provided by the physician, so modifier 26 denoting the professional component of the service would not be appropriate.
End-stage renal disease (ESRD) requires permanent dialysis. ESRD is reflected with CPT® codes 90951 thru 90970, depending on the services rendered. The codes are grouped according to the patient’s age and number of visits per month. Dialysis treatment codes are submitted monthly if the patient completes a full month of treatment. If the patient does not complete a full month of treatment, a daily dialysis treatment code would be reported. Evaluation and management services related to dialysis treatment for ESRD are bundled into the dialysis codes. However, if a physician addresses an unrelated condition during a patient’s treatment session, the E&M service can be billed separately if the documentation is clear and precise and the E&M code is accompanied by modifier 25, denoting a separately identifiable E&M service on the same day as the procedure. Other services bundled into the dialysis codes include: the physician’s assessment of the patient, counseling, phone calls, physician’s hemodialysis laboratory visits, patient’s treatment plan (dialyzing cycle), and nutritional and overall management of the patient. Dialysis can be performed in an outpatient dialysis facility or in an outpatient or hospital setting. The codes are billed on a monthly basis, and the keys to remember are:
- What type of dialysis is the patient receiving?
- What is the complexity of the service?
- How many visits is the physician provided to the patient?