Tips to prevent Denials in Nephrology Billing Services

With continuous change in medical coding and its rules, healthcare professionals and medical coders often will have a tough time navigating the complexity of nephrology billing and coding. With the implementation of ICD-10 coding, there came the necessity to code with a significantly higher level of specificity. Nephrology billing services have become more challenging with more regulations and new codes that have been released and changed in 2021.

It makes nephrology billing services even more complicated to navigate new levels of specificity and new codes. Nephrology billing practices must deal with the additional requirements from the insurance companies. After the significant changes that started with ICD-10, CPT codes, and E&M guidelines, nephrology billing services have continued to change by leaving the practices to deal with additional requirements from insurance companies and required specificity.

Many small mistakes can add up to expensive denials. It’s also crucial to learn to avoid or prevent common denials that occur in nephrology billing services. Few tips can help prevent these denials from occurring in the future.

Common mistakes in nephrology billing services:

  • While there are various reasons for claim denials, there are few most common errors in nephrology billing services that bring huge revenue loss.
  • Let us find out common mistakes first before learning the tips to avoid them.
  1. Submitting unspecified diagnosis:
  • With ICD-10 changes, there has been an increased emphasis to get more specific with the diagnosis while coding.
  • With the latest coding updates, the common trend is to provide as much as specificity possible to make sure the practice is safe from denials.
  1. Failure to show the documentation presenting the link or cause relationship between the diseases:
  • While coding multiple diseases, it’s essential to provide the documentation that presents the link or the cause between both.
  • In most cases, certain medical conditions must be coded together.
  • For instance, in hypertension and chronic kidney disease conditions, a common mistake is to code them separately while the documentation shows that a patient actually has renal hypertension that is causing their chronic kidney disease.
  1. Submitting Incomplete Codes:
  • Incomplete codes are one of the other common causes for denials. Submitting those codes that are missing a fourth, fifth or sixth digit that reveals greater specificity commonly results in a denial because specificity has become so significant in coding currently.

Tips to prevent denials in nephrology billing services:

  • Getting to know the methods to prevent denials is one of the best and experienced ways to avoid or prevent denials.
  • Few nephrology-specific tips should be kept in mind in order to avoid unnecessary denials.
  1. Always remember that hypertension is no more classified as benign, malignant, uncontrolled, or controlled.
  2. While coding for chronic kidney disease, it’s essential to document the stage of the disease.
  3. If acute renal failure is present, it must be stated.
  4. Diabetes mellitus is no longer classified as being uncontrolled or controlled.
  5. When coding diabetes, you must specify the type, such as drug or chemical induced, Type 1, Type 2, or due to an underlying medical condition.
  6. What used to be termed acute pyelonephritis is now termed acute tubulointerstitial nephritis.
  7. Chronic pyelonephritis has terminology that can be changed to chronic tubulointerstitial nephritis.
  8. Complications of diabetes, such as chronic kidney disease or nephropathy should have their manifestation specified, i.e., diabetes chronic kidney disease, and diabetic nephropathy.

Outsourcing nephrology billing:

  • As nephrology billing and coding services continue to be complex, most of the practices find outsourcing a better option to reduce practice expenses while enjoying greater coding accuracy and fewer denials.
  • Outsourcing to companies that specialize in nephrology coding makes sure that the nephrology practice uses the appropriate specificity while coding claims, maximizing per code collections and reducing denials.
  • Above all, outsourcing nephrology billing services can provide code utilization reports so that healthcare professionals can better understand which procedures are the most profitable for your practice.
  • Outsourcing also brings numerous benefits to the practices. When outsourcing to a better medical billing company, they will be working with experts who have greater resources and expertise than most medical practices.
  • Certified medical billing and coding teams stay on top of the latest coding updates, regulations, and laws, which can reduce your practice’s overall liability and prevent mistakes and fraudulent activities.

Requirements for Causative Codes:

  • When you’re using codes N17.0 through N17.9 for kidney failure, it’s important to code N18.1 through N18.5 for chronic kidney disease. Or they should use code N18.6 ESRD. Healthcare professionals will need to document their causative codes. The most common causative codes include hypertension, glomerular disease and diabetes.
  • It’s required to use:
  1. N17.9 – Acute kidney failure that’s unspecified
  2. N19 – Unspecified renal failure
  3. N26.1 – Atrophy of the kidney, terminal

Most important diabetes codes:

Type I Diabetes

  • E10.21 – Type I diabetes along with diabetic nephropathy
  • E10.22 – Type I diabetes along with diabetic chronic kidney disease
  • Additional code should be used to identify the stage of the patient’s chronic kidney disease
  • E10.29 – Type I diabetes with any other diabetic kidney complications like renal tubular degeneration

Type II Diabetes 

  • E11.21 – Type II diabetes along with diabetic nephropathy
  • E11.22 – Type II diabetes along with diabetic chronic kidney disease
  • Use an additional code to identify the stage of the patient’s CKD
  • E11.29 – Type II diabetes along with any other diabetic kidney complications like renal tubular degeneration
  • For insulin use, use additional code Z79.4

Codes for Documenting Chronic Kidney Disease:

  • 10 – Essential or primary hypertension
  • 12 – Hypertensive chronic kidney disease
  • This code requires the fourth digit as well
  • 12.0 – Hypertensive chronic kidney disease along with stage 5 chronic kidney disease or end stage renal disease
  • It’s essential to use an additional code in order to identify the specific stage of chronic kidney disease
  • 12.9 – Hypertensive chronic kidney disease, stages one through four chronic kidney disease, or chronic kidney disease that’s unspecified
  • Once again it’s necessary to use another code to identify the patient’s stage of chronic kidney disease.
  • 13 – Hypertensive heart and chronic kidney disease
  • This code also requires you to use the fourth digit.
  • 13.0 – Hypertensive heart and chronic kidney disease along with heart failure and stage one through four chronic kidney disease, or unspecified Chronic Kidney Disease.
  • Use an additional code to indicate the stage of Chronic Kidney Disease
  • Use an additional code to note the specific kind of heart failure
  • 13.10 – Hypertensive heart and chronic kidney disease without any heart failure along with stage one through four Chronic Kidney Disease
  • Stage of Chronic Kidney Disease must be noted with an additional code
  • 13.11 – Hypertensive heart and chronic kidney disease without any heart failure and with end-stage renal disease or stage 5 Chronic Kidney Disease.
  • Additional code for the stage of Chronic Kidney Disease must be used.

Benefits of Nephrology Billing Software

Multiple Claims Processing:

  • The historical way of filing the claims involved filing them individually for each patient to ensure it was done accurately and perfectly.
  • It not only consumes a lot of nephrology provider’s time but also increases the risk for misfiled claims, claims to go unbilled, and payments to delay.
  • Patients in hundreds consult providers for the same problem, and that’s where they require nephrology billing software.
  • It also prevents providers from having to file claims individually. Instead, this tool files hundreds of claims simultaneously.

Payer Clarification:

  • Depending on the insurance payer, a nephrologist can bill mid-month for a dialysis visit,or they have to wait until the end of the month.
  • Earlier, it was way too difficult to distinguish between which payer allowed for mid-month billing versus end-of-month billing.
  • This could be an excellent benefit to process is simple and efficient tasks by allowing the provider to never miss a payment from an insurance payer who allows for mid-month billing.

Maximize Reimbursements:

  • Each one of these benefits actually pays attention to Nephrology billing software’s ability to maximize reimbursements within the practice.
  • By identifying care, nephrology billing software can seek improvements where it requires and where certain services are to be offered.
  • You can focus on patients by increasing the quality of care that the practice needs to provide.

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