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:
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.
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:
Outpatient office visits-CPT codes 99201-99215
Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days, CPT code
99231-99233
Individual and group kidney disease education services codes G0420-G0421
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
Transitional care management services-CPT codes 99495-99496
Advance care planning-CPT codes 99497-99498
Prolonged service codes-CPT codes 99354-99357
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:
Document a full-contact physical exam that was not possible due to the clinical condition of the
patient.
Document any key findings that they can observe themselves.
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.
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:
It can be done via asynchronous or synchronous technology.
It can be done utilizing a patient transmitted photo or video, which requires follow-up with the
patient within 24 hours.
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:
These services must not be related to an office visit that occurred in the previous seven days
These services must not result in the patient being seen for a next available office appointment or
within 24 hours, and
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:
The onset of care
Site specificity (anatomically)
Laterality
Etiology and manifestation
The severity of the disease
Non-specific/unspecified
Combination codes
Any conditions that could add to and complicate treatment.
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