Monthly billing for patients on dialysis
Nephrologists care for patients with chronic kidney disease in the office and for patients on dialysis in units, at home and in the hospital. For patients with end-stage renal disease (ESRD), most outpatient physician work is paid through a monthly code rather than visit by visit, so the practice must track every patient’s age, dialysis setting and number of visits each month — including months cut short by hospital stays, travel or a change of treatment.
Monthly ESRD codes
| Situation | Codes | Based on |
|---|---|---|
| In-center dialysis, full month | 90951–90962 | Patient age group and number of face-to-face visits in the month (1, 2–3, or 4 or more) |
| Home dialysis, full month | 90963–90966 | Patient age group |
| Partial month (home or in-center) | 90967–90970 | Per day of service, by age group |
The monthly codes include ESRD-related visits during the month, so separate E/M visits for dialysis care are not billed. Visit dates and who performed each visit must be documented; for home dialysis patients Medicare allows some monthly visits by telehealth, with in-person visits still required at set intervals.
Hospital and inpatient dialysis
- Inpatient hemodialysis is billed per day with 90935 (single evaluation) or 90937 (repeated evaluations), and other dialysis procedures such as peritoneal dialysis or continuous therapies with 90945 or 90947.
- An E/M visit on the same day is billed only for a significant, separate problem, with modifier 25.
- Days in the hospital interrupt the outpatient month, which is then billed with partial-month codes or with fewer visits, depending on the situation.
Chronic kidney disease and access procedures
Before dialysis, nephrology care is billed with standard E/M codes, with CKD stage coded to full ICD-10-CM specificity. Medicare covers kidney disease education for patients with stage 4 CKD (G0420 individual, G0421 group) for a limited number of sessions. Practices performing dialysis access work bill the dialysis circuit codes (36901–36909) by the most intensive service in each segment of the circuit.
Coverage and payer order
Many patients become eligible for Medicare because of ESRD. For patients who also have employer group health coverage, that plan pays first during a 30-month coordination period, after which Medicare becomes primary. Setting the right payer order — and updating it when the period ends — prevents a cycle of denials and recoupments. See A/R management.