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Reply with quote  #1 
I am code E/M rounds for a nephrologist, and I'm having some trouble with the correct procedure for coding hemodialysis with other E/M services.

--From my research, it seems that I can't code 90935/90937 with a subsequent IP code (99231-99233) for Medicare patients.  Is this correct?  Does that rule apply to Medicaid also?  If I can't bill a subsequent and an HD on the same day, could I use 90937 (multiple visits during HD) to cover the multiple visits during the day, even if the other visit was hours earlier or later?  Or is 90937 only meant to be used if the Dr. visits the patient multiple times during one HD session?  Or is 90937 meant to be a subsequent code after the initial 90935?

--Also, I understand that I must append a modifier -25 to an initial IP code (99231-99233) if I want to bill an HD round also. 

--The problem comes in with Medicare's apparent definition of "other E/M service."  They seem to be saying that the other E/M service must be totally unrelated to the patient's HD and renal failure.  However, the nephrologist's consult will inevitably include elements pertaining to the renal problems (such as electrolyte imbalances, CKD, etc.) as well as other things (anemia, DMII, HIV, etc.).  Does the inclusion of renal Dx mean the consult can't be counted separately?  Or does the presence of even one unrelated Dx mean it can be billed separately?  Or is it alright to always bill for an initial consult, regardless of contents, on the same day as an HD?

Sorry for asking so many questions, but I'm trying to understand this issue since Medicare doesn't give a neat, concise definition and guidelines.

marcia lewis

Posts: 1
Reply with quote  #2 
The HD code 90935 or 90937 includes only time spent with the patient while he is on dialysis.  An earlier visit on the same day with the patient in the room does not count toward the HD code.  You may bill an initial hospital service on the same day as a dialysis procedure because the provider is usually addressing issues other than dialysis orders, e.g. hypertension, renal osteodystrophy, nutrition, etc.  In order to bill both, there must be 2 separate encounters, 1 for E&M and a separate visit for dialysis management and the E&M must have modifier 25 added.  Same is true for discharge services and hemodialysis on the same day.
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