Author Topic: Billing Codes for Home Dialysis  (Read 2614 times)

Alice Scott

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Billing Codes for Home Dialysis
« on: March 07, 2008, 05:05:05 AM »
Question
Hi, I am trying to obtain the billable codes for Home Dialysis (UB04) for Method 1 and 2, to include training.  The Reimbursement Connection mentioned I would bill the same as a free standing dialysis clinic, only that I would change the Place of Service to “Home”.  Condition Code? Value Codes used? CPT’s the same as MCR (90999) and commercial (90935)??  G-Code?? Please help……….
Ivette

Answer
Hi Ivette,
   I am a little confused by your question.  Why are you billing for Home Dialysis on a UB04 instead of the CMS form?  Are you credentialed as a facility? 
Thanks

Michele

Question
Hello Michelle……Thank you so much for responding.

I am not sure if UB IS the correct form to use.  I have 2 entities:  1 is a freestanding outpatient dialysis clinic with over 100 patients, which we bill on UB’s.  The other is the Doctors PA office (1500’s).  I will be opening a 3rd entity, catering to Home Dialysis, Method 1, with staff assisted treatments, but I don’t have a clue what CPT codes are used.  Do I bill the same as the in house hemo patients with a different place of service??  I currently bill 90999 (MCR Hemo) A4657 (admin fee) plus EPO and meds.  I also would like to know allowable CPT codes for the equipment.

All the research I’ve done tells me what my composite rates consist of but do not give me the CPT codes.  Can you help?

Ivette

Answer
Ivette,

   It sounds to me like you will be billing for the home dialysis, and for facility fees, but for professional fees and equipment.  If that is the case then you would bill on CMS forms with the same CPT codes (90918 – 90999) that you use for the Doctors office (if he is providing in office dialysis).  You would just use place of svc code 12 (home) instead of 11 (office).  You are providing the professional services plus equipment and meds, but in the patient’s home. 
I hope that helps you out.
Michele

Question
Thank you so much.  This does confirm what I needed to know……
Ivette
« Last Edit: March 07, 2008, 05:28:16 AM by Alice Scott »
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