Skip to main content

Helpful Tips to Prevent Denials in Nephrology Billing

November 7, 2018

Nephrology BillingWith continued changes to codes and rules, professional coders and physicians alike often have a tough time navigating the complexity of nephrology billing and coding. After the significant changes that came with ICD-10, CPT codes and E&M guidelines have continued to change, leaving practices dealing with additional requirements from payers and required specificity. Unfortunately, small mistakes can add up to costly denials, so it’s crucial to learn how to avoid the most common nephrology billing and coding errors and discover some of the best tips for preventing denials. 

Common Nephrology Billing and Coding Mistakes 

While there are many different reasons your nephrology claims may be denied, the following are some of the most common billing and coding mistakes that result in denials that disrupt the flow of practice revenue. 

Mistake #1 – Submitting Unspecified Diagnosis 

With ICD-10 changes, more emphasis has been placed on getting specific with a diagnosis when coding. With the latest changes in 2018 and for 2019, that’s continued to be the common trend – providing as much specificity as possible. Make sure your practice is 

Mistake #2 – Failing to Show Documentation Showing the Link or Cause Relationship Between Diseases 

When coding multiple diseases, it’s essential to show documentation that shows the link or cause between the two. In many cases, certain medical conditions should be coded together. For example, hypertension and chronic kidney disease. It’s a mistake to code these two separately when documentation shows that a patient actually has renal hypertension that is causing their chronic kidney disease. 

Related Article: Current Issues with ESRD and Dialysis billing

Mistake #3 – Submitting Incomplete Codes 

Incomplete codes are another common cause for denials. Submitting codes that are missing a fourth, fifth, or sixth digit that shows greater specificity commonly results in a denial because specificity has become so crucial in coding today.  

Nephrology: Tips for Preventing Denials 

Learning how to prevent denials is one of the best ways to keep revenue flowing for your nephrology practices. The following are some nephrology-specific tips to keep in mind to avoid unnecessary denials. 

  • Remember that hypertension is no longer classified as benign, malignant, uncontrolled, or controlled. 
  • When coding for chronic kidney disease, it’s essential to document the stage of the disease. 
  • If acute renal failure is present, it must be stated. 
  • Diabetes mellitus is no longer classified as being uncontrolled or controlled. 
  • When coding diabetes, you must specify the type, such as drug or chemical induced, Type 1, Type 2, or due to an underlying medical condition.
  • What used to be termed as acute pyelonephritis is now termed as acute tubulo-interstitial nephritis. 
  • Chronic pyelonephritis has the terminology changed to chronic tubulo-interstitial nephritis.
  • Complications of diabetes, such as chronic kidney disease or nephropathy should have their manifestation specified, i.e., diabetes chronic kidney disease and diabetic nephropathy.

Outsourcing to Reduce Nephrology Practice Expenses

Because nephrology billing and coding continues to be so complex, many practices find that outsourcing offers an excellent way to reduce practice expenses while enjoying greater coding accuracy and fewer denials. Outsourcing to a company that specializes in nephrology coding will ensure that your practice does use the appropriate specificity when coding claims, maximizing per code collections and reducing denials. Beyond that, a good company can also provide you with code utilization reports so you better understand which procedures are the most profitable for your practice. 

Outsourcing offers a number of specific benefits to nephrology practices. When you outsource to a quality company, you’ll be working with experts who have greater resources and expertise than most medical practices. Certified coders and billers stay on top of the latest coding updates, regulations, and laws, which can reduce your practice’s overall liability and help prevent mistakes and fraud. Employing a full internal billing and coding staff on site can be expensive as well, and outsourcing can be a more cost-effective option. 

If you’re ready to outsource your nephrology billing and coding to professionals, M-Scribe, can help. We work with nephrology practices across the country, helping them reduce denials, improving collections, and increase practice revenue. Contact M-Scribe today to find out more about how we can help your nephrology practice. 


Get the Latest RCM News Delivered

Receive practical tips on medical billing and breaking news on RCM in your inbox.

Get in Touch