Codes will all depend on if it's inpatient or outpatient. I've listed what I know below to get you started. EDITED TO ADD SOME MORE PDFS.
Outpatient: Usually involves billing once a month and usually code ranges from 90951-90962 and the codes are based on how many days say 4x a month for someone 12-19 years of age. It's really simple once you understand the parameters of each code. For example, 90961 is end-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified health care professional per month. So the codes will always be based on age and the number of face-to-face encounters w/the patient during the month. The main codes for adults are usually: 90960, 90961, 90962, and 90966, which is for home service;end-stage renal disease (ESRD) related services for home dialysis per full month, for patients 20 years of age and older. The code range for home dialysis is: 90963-90970, again each code tells what age range and full month. There is also home training codes, which are 90989 and 90993, which would be used if there is training done on the home dialysis. Please note you can bill some of these codes w/E/M service that's non-renal related. Now 90967-90970 ESRD codes are used for less than a full month of service, and when a patient was in the hospital, but say came home and received dialysis, again all based on age, with 90970 being the one you'll probably use the most as it's - 90970 end-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 20 years of age and older. So as an example say a patient was in the hospital from Marc 1st until the 19th, and your client saw the patient once they got out for dialysis from the 20th until the 31st of March, then you'd bill 90970 x 12 units. There is a link to a MAC NGS pdf below, that gives better examples and goes into detail on everything stated here.
Inpatient: Is all about the attending physician/qualified health professional being present during/while the patient is undergoing dialysis. They must be present or it's not reimbursable as far as I know, you can double check your coding books, but 90935 - Hemodialysis procedure with single evaluation by a physician or other qualified health care professional, 90937, 90945, and 90947 - look into all these codes. You also need to look into the G code for Medicare: G0257 - which means unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility, which may come up if you're doing billing for a hospital facility. Medicare has MCP (monthly capitation payments and their pdfs explains a lot of this below:
There are no modifiers on the above codes as far as I can tell from my info. There are other aspects of renal billing that do require modifiers, like injections, supplies, separately billable ESRD drugs, etc. The last PDF from CMS should help you with understanding those, and usually list the modifiers needed/required by at least CMS.
This will be an extremely helpful pdf from Medicare University from MAC NGS about Part B and goes into both hospital/outpatient, monthly capitation payment codes and how they work, etc -->
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CDAQFjAA&url=http%3A%2F%2Fapps.ngsmedicare.com%2FADC%2Fdisplaymedia.aspx%3FwhatToDo%3Dattch%26id%3D1708&ei=rRNbUef7GtXF4APb6YHYCw&usg=AFQjCNHfywN-KBilxesePztgfuqdKc5NtA&sig2=ctvet9ZxsIUx_TP9TxJ0YQ&bvm=bv.44697112,d.dmgHere is an updated CMS pdf from 2012 I believe clarifying how to bill for outpatient etc:
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2455CP.pdfAlso see this CMS pdf for outpatient ESRD, hospitals, independent facilities, and physician/suppliers, claims -->
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c08.pdf - this will give you in-depth info on each level, etc.
