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  1. #1
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    Default Question about billing PD Patient

    Hi,

    I would like to know how to bill for a patient that was on home PD until the 26th of the month and then switched to hemodialysis for the remainder of the month. Should I bill 90966 for PD or 90961 for 2-3 face-to-face physician visits?

    Thanks.

  2. #2
    Join Date
    06-25-04
    Location
    Kansas
    Posts
    1,769

    Default

    You can find answers to several Medicare questions here.
    http://www.homedialysis.org/professionals/medicare

    According to the Medicare Claims Processing Manual, Chapter 8:

    140.1.2 - Patients Who Switch Modalities (Center to Home and Vice Versa)
    (Rev. 1999, Issued: 07-09-10, Effective: 01-01-11, Implementation: 01-03-11)

    If a home dialysis patient receives dialysis in a dialysis center or other outpatient facility during the month, the MCP physician or practitioner is paid the management fee for the home dialysis patient and cannot bill the ESRD-related services codes for managing center based patients.

    This situation should be coded using the ESRD–related services codes for a home dialysis patient per full month. Physicians and practitioners should use the ESRD–related services codes for a home dialysis patient per full month when billing for outpatient ESRD-related services when a home dialysis patient receives dialysis in a dialysis center or other outpatient facility during the month.

    Physicians and practitioners should use the ESRD–related services codes for a home dialysis patient per full month for patients that switch modalities regardless of whether the ESRD beneficiary went from home dialysis to center-based dialysis, or vice versa, and regardless of the proportion of the month that the beneficiary was receiving each modality.

    http://www.cms.gov/manuals/downloads/clm104c08.pdf
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

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