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Module 12: CPT AND ICD-10 DIAGNOSTIC CODING FOR DIALYSIS ACCESS A Practical Guide to Documentation and Meeting the Rules and Regulations

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This activity is jointly provided by Global Education Group and Kidney Academy.

Target Audience 

 The educational design of this activity addresses the needs of physicians and adjunct health care professionals (e.g., nurses, technologists) who treat kidney disease. Medical specialties addressed are relevant to transplant surgeons, radiologists, nephrologists, and vascular surgeons. (Only Relevant to United States Audience)

 

Statement of Need/Program Overview

There are two key items for physicians when coding and billing for services rendered to patients of kidney dialysis.  They are 1) coding compliance and 2) documentation reflecting the patient’s severity of illness. The clinical decision making with the appropriate treatment plan protocol documentation is reflected to the insurance payer only through the ICD-10 diagnostic codes and the CPT procedure codes.  Patients with multiple co-morbid conditions, when coded appropriately, demonstrate the quality of care rendered to the patient and that information goes towards the profile of severity of illness, which equals data gathered for insurance reimbursement.  Data quality will be reviewed by most insurance companies and government entities that give “guidance” of payment through the lens of meeting medical necessity for services rendered.  This module provides coding compliance advice along with key documentation requirements that will keep the provider ahead of the insurance denial pathway.

 The authors realize that because of differences in opinions, practice styles between individual providers as well as geographical variations, the coding may and can vary. This publication should be looked upon as a guide or an example of one approach. Also, because of the changing practices with outpatient dialysis access centers where radiology and surgery procedures are performed in one setting, proper CPT coding related to vascular access becomes even more crucial, not just for reimbursement, but also for statistical and patient management purposes. 

Learning Objectives

  1. Upon completion of the educational activity, participants should be able to:
  2. Understand the coding/documentation compliance requirements.
  3. Review basic guidelines from AMA and CMS for Evaluation and Management Documentation regarding physician patient visits updated 2021.
  4. Understand the concept for “global packaging”, regarding CPT coding and modifiers.
  5. Verbalize the definition of the ICD-10 diagnostic history and how unspecified statements may result in non-payment.
  6. Outline the key elements in the patient’s documentation to capture the appropriate ICD-10 diagnostic assessments.
  7. Define of complication of coding for Thoracic Central Vein Obstruction (T-CVO) (in Module 7) and Dialysis Access Steal Syndrome (DASS) (in Module 8).
  8. Understand the Medicare Access and CHIP Reauthorization Act (MACRA) physician fee schedule signed into law in 2015, which allows for the collection of quality data.
  9. Review Office of Inspector (OIG) audit results for Medicare and ESRD.

Faculty 

Diana J. Adams, RHIA
Ingemar Davidson, MD, PhD, FACS 


Program Agenda Introduction And Multi-Level Learning Design To Optimize Learning

Summary: CPT and ICD-10 Diagnostic Coding for Dialysis Access

  1. Pre-Test For Module 12  With 20 Multiple Choice Questions
  2. Introduction To CPT and ICD 10 Coding for Dialysis Access
  3. Current Upgrading CPT and ICD10
  4. Surgical Global Package
  5. ICD -10-Cm Coding Guidelines
  6. Coding For Dialysis Access Complications
  7. ICD-10 Coding for Chronic Conditions (Co-Morbidity)
  8. CPT Codes Categories
  9. CPT Codes for Hemodialysis  and Peritoneal  Dialysis
  10. Coding and Documentation Compliance
  11. Post-Test For Module 12  with 20 Multiple Choice Questions
  12. Take a Short Survey  Print Your Certificate (14/20 correct Answers required)


Key:

Complete
Failed
Available
Locked
SECTION 1: INTRODUCTION
There are two key items for physicians when coding and billing for services rendered to patients of kidney dialysis. They are 1) coding compliance and 2) documentation reflecting the patient’s severity of illness. The clinical decision making with the appropriate treatment plan protocol documentation is reflected to the insurance payer only through the ICD-10 diagnostic codes and the CPT procedure codes. Patients with multiple co-morbid conditions, when coded appropriately, demonstrate the quality of care rendered to the patient and that information goes towards the profile of severity of illness, which equals data gathered for insurance
SECTION 2: PRE-TEST
20 Questions  |  Unlimited attempts  |  0/20 points to pass  |  Graded as Pass/Fail
20 Questions  |  Unlimited attempts  |  0/20 points to pass  |  Graded as Pass/Fail Quiz contains 20 questions worth 20 points and requires 0 points to pas
SECTION 3. - CPT AND ICD-10 CODING FOR DIALYSIS ACCESS
CPT AND ICD-10 CODING FOR DIALYSIS ACCESS There are two key items for physicians when coding and billing for services rendered to patients of kidney dialysis.
SECTION 4: KEY ABBREVIATIONS
In the process of upgrading this section of coding for dialysis access there were changes in evaluation and management documentation (2021) but coding has had few changes since (2018). Insurance reimbursement changes have been minimal. The following is an overview of key abbreviations that one needs to know:
SECTION 5: SURGICAL GLOBAL PACKAGE
Is there an insurance system standard definition of “global surgical package”? The Current Procedural Coding (CPT) manual, produced by the American Medical Association (AMA) gives an overview of the definition of the surgical package. The following is a basic standard to the surgical package definition, which is maintained by the National Correct Coding Initiative (CCI) that is a national guideline per CMS regulations:
SECTION 6: ICD-10-CM CODING GUIDELINES
The overall goal/objective of this coding documentation module is to share the pathway to compliance. Per the Office of Inspector General (OIG) under the False Claims Act [31 U.S.C. Section 3729-3733] it is illegal to submit claims for payment to Medicare or Medicaid that knowingly are false or fraudulent. Good documentation practice helps ensure that patients receive appropriate care from you and other providers who may rely on records for patents’ past medical histories.
SECTION 7: CODING FOR DIALYSIS ACCESS COMPLICATIONS
ICD-10-CM Coding for Complications of a dialysis fistula either arterial side (AV graft) or venous side follow specific 7th character notations for which encounter the physician is treating.
SECTION 8: ICD-10 CODING FOR CHRONIC CONDITIONS (CO-MORBIDITY)
ICD-10-CM Coding –Chronic Conditions-Data Quality Tracking by CMS/Medicare
SECTION 9: CPT CODES CATEGORIES
Code descriptions for the appropriate code that reflects the treatment that the patient is receiving.
SECTION 10: CPT CODES FOR HEMODIALYSIS AND PERITONEAL DIALYSIS
Codes for hemodialysis and peritoneal dialysis, Hemodialysis is not specifically discussed in this module but the codes are listed for a reference guide.
SECTION 11: CODING AND DOCUMENTATION COMPLIANCE
Approximately 20 years ago, the Office of Inspector General (OIG) – as a part of the Department of Health and Human Services (houses CMS), gave warning to physicians, hospitals, and even third party billers, to develop and implement compliance programs that would include processes for ensuring that the services they provide to patients are “medically necessary” and that the care is of high quality.
SECTION 12: POST TEST
20 Questions  |  Unlimited attempts  |  0/20 points to pass  |  Graded as Pass/Fail
20 Questions  |  Unlimited attempts  |  0/20 points to pass  |  Graded as Pass/Fail POST Quiz contains 20 questions worth 20 points and requires 0 points to pass
SECTION 13: CME MANDATORY MODULE SURVEY
6 Questions
SECTION 14: DOWNLOAD CERTIFICATE
Live Viewing: 3.00 CME credits and certificate available
Live Viewing: 3.00 CME credits and certificate available