Health Information Management

Q&A: Facility codes for peritoneal dialysis

JustCoding News: Outpatient, February 8, 2012

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QUESTION: We are a nondialysis facility, so when a patient is in observation for some other reason and must undergo hemodialysis, we report code G0257 (unscheduled or emergency dialysis treatments for an ESRD [end stage renal disease] patient in a hospital outpatient department that is not certified as an ESRD facility). But how should we code peritoneal dialysis when a patient is in observation or inpatient for other problems? I have received three different codes from different coders. I cannot really find any information on this anywhere.

ANSWER: CodeG0257 does not include any evaluation and management (E/M) services that a physician may provide related to the patient’s renal condition.

Use codes 90935 (hemodialysis procedure with single physician evaluation) or 90937 (Hemodialysis procedure requiring repeated evaluations) to report the provision of hemodialysis along with E/M services provided by the physician on the same day. As per CPT® guidelines, report these codes for the provision of inpatient hemodialysis to either an ESRD or non-ESRD patient as well as services for an outpatient non-ESRD patient.

Therefore, check the documentation to determine if the physician provided evaluation and management services in relation to the dialysis and whether the patient has ESRD. This answer should lead you to the correct code.

Editor’s note: Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

Need expert coding advice? Submit your question to Senior Managing Editor Michelle Leppert, CPC-A, at mleppert@hcpro.com, and we’ll do our best to get an answer for you.



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