Why Nephrology billing is different.
Nephrology billing expertise.
- Monthly capitation billing by age and visit count
- Per-day ESRD billing for partial months
- Inpatient hemodialysis and peritoneal dialysis evaluations
- Home dialysis training and supervision billing
- Vascular access procedure coding
- CKD office visit and E/M billing
- Multi-site visit tracking and reconciliation
- Medicare secondary payer coordination for ESRD patients
Common Nephrology codes we work with.
| Code | Description |
|---|---|
90960 | ESRD-related services monthly, age 20 and older; 4 or more face-to-face visits per month |
90961 | ESRD-related services monthly, age 20 and older; 2-3 face-to-face visits per month |
90962 | ESRD-related services monthly, age 20 and older; 1 face-to-face visit per month |
90970 | ESRD-related services for dialysis less than a full month of service, per day; age 20 and older |
90935 | Hemodialysis procedure with single evaluation by a physician or other qualified health care professional |
90945 | Dialysis procedure other than hemodialysis, with single evaluation by a physician or other qualified health care professional |
CPT® is a registered trademark of the American Medical Association. Codes shown are examples; correct coding depends on documentation and payer policy.
Our processNephrology billing process.
Patient Setup and Eligibility
- ESRD Medicare entitlement and coordination period tracking
- Secondary and supplemental coverage verification
- Dialysis unit and hospital census reconciliation
- Demographics shared across rounding sites
Visit Tracking and Coding
- Monthly visit counts per patient and provider
- Correct monthly or per-day ESRD code selection
- Inpatient dialysis evaluation coding
- CKD office visit E/M review
Claim Submission
- Month-end capitation claim generation
- Scrubbing for overlapping inpatient days
- Accurate place of service and dates
- Timely electronic submission after month close
Denial Management
- Coordination of benefits corrections
- Overlap and duplicate service resolution
- Medicare secondary payer appeals
- Underpayment follow-up
Analytics
- Capitation revenue by dialysis unit
- Visit compliance by provider
- Inpatient versus outpatient revenue mix
- Payer and aging trends
Nephrology billing FAQs.
How is the monthly ESRD code chosen?
For in-center patients, the code depends on the patient's age and the number of face-to-face visits during the month. Four or more visits supports the highest level, so accurate visit tracking directly affects revenue.
What happens when a dialysis patient is hospitalized mid-month?
If the patient doesn't receive a full month of outpatient ESRD services, a per-day code may apply instead of the monthly code, depending on the circumstances. We review each partial month to apply the correct billing method.
How do you track visits across multiple dialysis units?
We reconcile rounding logs from each unit and hospital at month-end so every visit is counted and assigned to the right provider before claims go out.
Do you handle ESRD coordination of benefits?
Yes. For patients with employer group coverage, Medicare is often secondary during the 30-month coordination period. We track these timelines so claims go to the correct primary payer.