Medical Service



Nephrology is the subspecialty of internal medicine that focuses on the diagnosis and treatment of diseases of the kidney.

Nephrologists also help in managing fluid, electrolyte, and acid-base disturbances, particularly those occurring in advanced kidney disease.

A major role of nephrology is the oversight of dialysis (including hemodialysis and peritoneal dialysis) in patients requiring renal replacement therapy, and participation in the kidney transplant process, if indicated.

  • 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.

    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.

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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