The document provides guidance on coding and billing for end-stage renal disease (ESRD) services. It discusses: 1) New ESRD CPT codes 90951-90970 that replaced G codes and older CPT codes for capturing physician work related to dialysis patients. 2) Guidelines for billing monthly or daily codes based on whether it is for a full or partial month of service. 3) Requirements for documentation of ESRD services to support billing codes. 4) Rules around billing for teaching physicians, hospitalization, home dialysis training, infusion codes, and consultations vs. referrals.

1. Code for Documentation! Audit for Compliance! Richard J Hamburger MD Professor Emeritus of Medicine Indiana University Indianapolis IN Debra H. Lawson, CPC, PCS Nephrology Billing & Management Services, LLC Rogersville, TN

14. MCP GUIDELINES A POLICY REVIEW

39. HOME DIALYSIS TRAINING

44. CONSULT V REFERRAL CORRECT CODING CAN MEAN $$$$ INCORRECT CODING….

68. DISCHARGE MANAGEMENT SERVICES

74. NEPHROLOGY SPECIFIC CPT CODING

80. 90937 vs CRITICAL CARE WHEN IS EACH APPROPRIATE?

81. CODING FOR CRITICAL CARE

99. Compliance Assessment

103. 2009 Nephrology Specific PQRI Measures MEASURE NUMBER MEASURE DESCRIPTION REPORTING OPTIONS END STAGE RENAL DISEASE (ESRD) 79 Influenza Immunization in Patients with ESRD Claims, Registry 81 Plan of Care for Inadequate Hemodialysis Registry 82 Plan of care for Inadequate Peritoneal Dialysis Registry CHRONIC KIDNEY DISEASE (CKD) 121 Laboratory Testing (calcium, phosphorus, intact parathyroid hormone (iPTH) and lipid profile) Claims, measures group (MG), and Registry 122 Blood Pressure Management Claims, MG, and Registry 123 Plan of Care for Elevated Hemoglobin for Patients Receiving ESA Therapy Claims, MG, and Registry 135 Influenza Immunization in Patients with CKD Claims, MG, and Registry 153 Referral for AV Fistula Claims, MG, and Registry

105. 03 17 09 03 17 09 11 99213 1 50 00 123456789 03 17 09 03 17 09 11 3278F 1 0 00 123456789 585.5 03 17 09 03 17 09 11 3281F 1 0 00 123456789 Make sure that diagnosis is included in the PQRI measure specifications Each PQRI measure must have individual NPI # PQRI claims MUST contain a service (CPT) code that is included in the PQRI measure denominator 03 17 09 03 17 09 11 4171F 1 0 00 123456789 03 17 09 03 17 09 11 4037F 1 0 00 123456789

108. BILLING FOR ERYTHROPOIETIC STIMULATING AGENTS