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August 11, 2011, 09:56 AM #1Unregistered Guest
Question about billing PD Patient
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?
September 3, 2011, 07:12 PM #2Resource/Policy Associate Registered User
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You can find answers to several Medicare questions here.
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.pdfBeth Witten MSW ACSW LSCSW
Medical Education Institute, Inc.
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