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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

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.