Ask the Expert

This month’s selection:
A licensed outpatient dialysis center is part of our hospital setting. When a hemodialysis patient comes in for weekly dialysis treatment (three times per week every week), what is the correct way to CPT code this account? I believe it is based on the outpatient monthly CPT code, the number of times evaluation and management is performed by physician, and age. So, for example, for a patient who is older than 20, I believe the correct codes are 90960, 90961, and 90962.

Brenda L. Melone, RN, CPUR, CPC
Director of Outpatient Coding Services
Rhode Island Hospital
Providence, Rhode Island

Response:
Per CPT guidelines in the Medicine dialysis section under the End-Stage Renal Disease Services heading, a code is reported once per month based on the number of face-to-face visits for end-stage renal disease services. So in the example presented above, for this patient who has four or more face-to-face visits with a physician or other qualified healthcare professional per month, the correct code assignment would be 90960. Codes 90961 and 90962 are not appropriate, as they are not add-on codes. The code is based on the total of visits per month and in this case, it is four or more, which is satisfied with code 90960.

— Cathie Wilde, RHIA, CCS, is vice president of coding at MRA and has extensive experience in ICD-9-CM and CPT coding, auditing, data analysis, development and testing of coding products, specialized reporting, and in-service training.