Dialysis can be performed in one of two ways: either hemodialysis or peritoneal dialysis. Hemodialysis is performed at a dialysis center or at home, while peritoneal dialysis is performed at home. Hemodialysis will require an arteriovenous fistula, graft, or catheter inserted in the chest. Peritoneal dialysis requires a catheter being inserted into the abdominal region.
Source: https://cfkc.org/post/hemodialysis-vs-peritoneal-dialysis-which-is-right-for-you
The Medicine section of CPT houses the codes for dialysis. Inpatient hemodialysis for ESRD and non-ESRD patients is captured with either code 90935 or 90937. These codes apply to outpatients having non-ESRD treatment. The difference between the codes is related to the frequency of physician or other qualified healthcare professional (QHP) evaluation of the patient. If there is a single evaluation, code 90935 should be assigned. If, however, repeated evaluation(s) are necessary, whether or not there is any change made to the dialysis prescription, then code 90937 is assigned. If a non-physician healthcare professional provides a home visit for a hemodialysis, a note in the CPT manual directs coding professionals to assign 99512. When using code 99512, the term “home” can mean the patient’s own home, assisted living, a group home, a custodial care facility, a school, or a nontraditional private home.
There are two codes that could be assigned for dialysis administered in a method other than hemodialysis. Those methodologies include peritoneal dialysis, hemofiltration, or other continuous renal replacement therapy. As with the hemodialysis codes, the two codes available for the “other” dialysis are also distinguished by how many evaluations are performed. A single evaluation is coded to 90945, and if repeated evaluations are necessary, the proper code is 90947. If a non-physician healthcare professional provides home infusion for peritoneal dialysis code 99601 is assigned per visit for up to two hours. Any additional hours of infusion can be reported by using add-on code 99602.
Also in the Medicine section are codes for end-stage renal disease services that are provided in an outpatient setting. There are three levels of service which are billed once per month (month equates to 30 days per CPT). The levels are distinguished by the number of face-to-face visits between the patient and provider. The levels are:
- 4 or more face-to-face visits
- 2-3 face-to-face visits
- 1 face-to-face visit
Each level is then broken down by age group. Those groupings are:
- Under age 2
- Ages 2-11
- Ages 12-19
- Ages 20 and older
One set of codes, 90951-90962, is for assignment when the patient is in an outpatient setting. The other set of codes, 90963-90966 are assigned for home dialysis patients.
Another set of codes, 90967-90970, is for patients that have received dialysis services for less than a month and under the following circumstances:
- The patient was transient
- Partial month with at least one face-to-face visit, but without a complete assessment (When a complete assessment has been done during the month, but there is less than a full month of services, it is appropriate to use the full month codes, as appropriate, from 90951-90962)
- Patient hospitalized before complete assessment was done
- Patient experienced recovery or death
- Patient received a transplant
An important note about codes 90967-90970 is that they should be assigned per day, not just once for the partial month.
Now, light has been shed on coding dialysis.
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About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP, is an HIM professional with over 25 years of experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA, along with being an AHIMA-approved ICD-10-CM/PCS trainer. Dianna has held many positions in HIM and is now an independent coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna is an AHIMA-published author and has volunteered with AHIMA on projects including certification item writing, certification exam development, coding rapid design, and most recently has served on AHIMA’s nominating committee. She is a presenter on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
