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Nephrology Medical Billing Services and ICD-10 Coding

March 18, 2013

nephrology medical billingWe’re a professional medical billing service company, providing specialty specific billing and coding services. It isn’t always easy work, as you might imagine. Every medical specialty has its own quirks and nuances when it comes to specialty medical billing and coding. The documentation needs to match the information that is contained a healthcare claim, and the technical language unique to each specialty needs to be clear and concise for auditors and coders.

What makes our job difficult at times isn’t that we don’t understand nephrology billing. Our expert staff understands it quite well. Sometimes, however, other people have a hard time grasping the ins and outs of this specialty. We can’t blame them. Medical billing overall isn’t the most exciting subject, unless you make it your career, of course. At M-Scribe, professional medical billing is what we are all about. 

Nephrology is the study and treatment kidneys diseases. Which is usually affected by other systemic diseases such as autoimmune diseases or diabetes mellitus. It can also cause systemic complications such as hypertension and osteodystrophy. Electrolyte imbalances, acidosis, kidney stones, polycystic kidneys, vasculitis, proteinuria and hematuria can all be linked to kidney dysfunction. In the most extreme cases, chronic renal failure can require dialysis or renal transplant.

Learn More: Advantages of Specialty Specific Medical Billing Experts

A number of procedures are ordered and used to diagnosis and treat renal disease. All of the procedure and diagnosis codes used for nephrology billing are governed by guidelines and medical protocols published by third party payers, including CMS, Medicaid, and commercial healthcare insurers. The codes used to bill for nephrology services need to match a particular payer’s guidelines.

We were talking with a client who has been in renal practice for a number of years. Like many physicians, this nephrologist has been making a comfortable income and meeting financial benchmarks that his accountant set for his outpatient practice.  At M-Scribe, we have accounting and bookkeeping backgrounds, but our focus is on legally maximizing reimbursement based on payer guidance and medical record documentation. Many nephrology practices forego potential income by not considering the possibility of add-on services. It takes a professional billing company to be able to recognize opportunities that pre- and post-payment audits reveal. 

When a physician encounters a patient face-to-face during a dialysis session, while obtaining a needle core biopsy, or when performing an renal ultrasound in the office, the evaluation and management services related to the primary procedure are not un-bundled. They are considered integral to performing the procedure.There are times, however, when additional E/M services are provided.  When these are adequately documented, these should be billed with the appropriate modifier to receive payment for medically necessary services provided.  There is nothing illegal about this. It is not considered up-coding or overcharging when coded correctly and justified in the medical record. Going over these requirements and explaining them to this provider is what kept us busy this week at our office in Atlanta.

In ICD-10-CM diseases of the genito-urinary system fall under the code sets N00-N99. Like other ICD-10 codes, those used to describe renal conditions are greatly expanded compared to the options available in ICD-9-CM. The additional characters and the increased specificity required under ICD-10 will present a challenge to medical coders and billers as they translate the medical encounter into a reimbursable healthcare claim. Providers need to be familiar with the new coding system, as well. Working together, physicians and medical billers can ensure that clean claims are submitted and cash flow won’t be impacted when the mandated ICD-10 transition takes place in the near future.


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