Telehealth has been a savior in healthcare industry since Covid-19. We can’t deny the fact that telehealth has paved a way for many healthcare specialty practices. Nephrology billing and coding also have been benefited via telehealth as it’s considered to be one of the toughest and crucial specialties in medical billing and coding.  To facilitate care provided to Medicare beneficiaries in the era of social distancing, Center for Medicare and Medicaid Services have expanded telehealth benefits on a temporary and urgent basis under the 1135 waiver authority and Covid-19 Preparedness and Response Supplemental Appropriations Act.

Medicare’s present guidance on telehealth for nephrology billing and coding includes the previous telehealth guidance that has been issued in the month of January, 2019. Changes were made to originating site and geographic restrictions to facilitate remote services to kidney patients in March 2020. Nephrology billing and coding companies help the healthcare practices report the remote visits for dialysis patients accurately based on updated telehealth policies.

Important things to note in Nephrology billing and coding:

  • The new regulations of nephrology billing and coding include guidelines for nephrology services provided to non-ESRD and dialysis patients.
  • All the healthcare professionals, whose activities are related to the end stage renal disease (ESRD), monthly capitation payment (MCP) outpatient dialysis services can be provided via telehealth.
  • There are two crucial points to note about the expanded telehealth regulations for nephrology billing and coding:
  1. The telehealth regulations actually allow the nephrology practices to use telehealth platforms in order to conduct dialysis for patients, who are treated at outpatient clinics. Earlier, such services were allowed only for the patients on home dialysis.
  2. These regulations are valid for patients with chronic kidney disease but not for patients who are in dialysis. Healthcare practices can still bill for nephrology services for the same monthly capitalized payments for the visits. But it is necessary that the nephrologist makes a live once-a-month visit with the patient in the dialysis clinic or in an office setting.

Key points of current nephrology billing and coding guidelines:

  • An originating site is the location where the Medicare beneficiary gets nephrologist medical services through a telecommunications system. Apparently, the patient’s home is now an approved originating site for telehealth services.
  • The list of approved distant site practitioners is as follows: Physician and practitioner offices. Hospitals, Critical Access Hospitals (CAHs), Rural Health Clinics, Federally Qualified Health Centers, Hospital-based or CAH-based Renal Dialysis Centers (including satellites), Skilled Nursing Facilities (SNFs), Community Mental Health Centers (CMHCs), Renal Dialysis Facilities, Homes of beneficiaries with End-Stage Renal Disease (ESRD) getting home dialysis, and Mobile Stroke Units.
  • The list of the approved telehealth services include:
  1. Outpatient office visits-CPT codes 99201-99215
  2. Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days, CPT code 99231-99233
  3. Individual and group kidney disease education services codes G0420-G0421
  4. All outpatient dialysis services, in-center and home, adult and pediatric, monthly and daily, with the exception of the single visit monthly dialysis codes for all ages, CPT codes 90956, 90959, and 90962
  5. Transitional care management services-CPT codes 99495-99496
  6. Advance care planning-CPT codes 99497-99498
  7. Prolonged service codes-CPT codes 99354-99357
  8. Telehealth consultations, critical care-CPT codes G0508-G0509
  • All the telehealth claims including nephrology billing and coding should be submitted with Place of Service. It indicates if the healthcare provider has furnished the billed service as a professional telehealth service from a distant site.
  • The expanded telehealth services are provided to both new and established patients.
  • The documentation requirements for billing patients in isolation:
  1. Document a full-contact physical exam that was not possible due to the clinical condition of the patient.
  2. Document any key findings that they can observe themselves.
  3. Document key physical findings from the healthcare professional who has most recently examined the patient and explain why those findings are critical for their renal care.
  4. Bill at the appropriate level for what the physician “would have done” and document the amount of time spent on the history and physical exam, focusing on time as it may be meaningful in the event of an audit.
  • CPT codes 99441-443 for Telephone Evaluations: After lifting of the geographic restrictions for normal E&M services, physician activities can be captured using telephonic codes that could be provided using E&M codes, when two-way audio and video capabilities are utilized.
  • Service code G2010 for Evaluation of Recorded Videos or Images-Review of recorded videos or images:
  1. It can be done via asynchronous or synchronous technology.
  2. It can be done utilizing a patient transmitted photo or video, which requires follow-up with the patient within 24 hours.
  3. They are only for established patients, not within 7 days but after1 day prior to an E/M service.
  • Service code G2012 for ‘Virtual’ Check-Ins-Brief , check-in with an established patient:
  1. These services must not be related to an office visit that occurred in the previous seven days
  2. These services must not result in the patient being seen for a next available office appointment or within 24 hours, and
  3. These services require 5 to 10 minutes of medical discussion.
  • Technology-CMS allows the use of telecommunications technology that has audio and video capabilities for two-way, real-time interactive communication.
  • Additionally, CMS has also authorized use of telephones that have audio and video capabilities for the furnishing of Medicare telehealth services during the Covid-19 PHE.
  • Penalties for HIPAA violations will be waived for healthcare professionals who serve patients in good faith through communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide PHE. This does not allow the use of audio only telephones.

Nephrology documents:

  • Submitting less specified codes usually will result in penalties and denied claims, not only with Medicare, but also with many commercial insurance companies.
  • To ensure that nephrology billing and coding for specific diagnosis is accurate, it’s necessary to concentrate more on documentation in detail.
  • Nephrology billing and coding will require the below documentation:
  1. The onset of care
  2. Site specificity (anatomically)
  3. Laterality
  4. Etiology and manifestation
  5. The severity of the disease
  6. Non-specific/unspecified
  7. Combination codes
  8. Any conditions that could add to and complicate treatment.

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