Health Information Management

Outpatient dialysis codes change

APCs Insider, August 12, 2003

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Back up the coding truck! CMS has changed the codes for physician services for outpatient acute hemodialysis services, retroactive to January 1, 2003. Claims from that date on should be processed using codes 90935 and 90937. These codes were originally used only for inpatient services.

The change becomes effective Oct. 1, 2003, says CMS' Transmittal 1810, which provides changes to the Carriers Manual, Part 3 Claims Process.

Payment is bundled for all E/M services that are related to the patients' renal disease and provided on the same date as the dialysis. Use codes 90935 and 90937, and for all non-hemodialysis procedures use 90945 and 90947.

However, the following E/M services can be reported separately if they are performed on the same date as dialysis and are unrelated to the dialysis. Use modifier -25 with these services and make sure they are separately identifiable and meet any medical necessity requirements.

  • 99201-99205: Office or Other Outpatient Visit for a New Patient

  • 99211-99215: Office or Other Outpatient Visit for an Established Patient

  • 99221-99223: Initial Hospital Care for a New or Established Patient

  • 99238-99239: Hospital Discharge Day Management Services

  • 99241-99245: Office or Other Outpatient Consultations, New or Established Patient

  • 99251-99255: Inpatient Consultations, New or Established Patient

  • 99291-99292: Critical Care Services

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