Module 12: CPT AND ICD-10 DIAGNOSTIC CODING FOR DIALYSIS ACCESS A Practical Guide to Documentation and Meeting the Rules and Regulations
This activity is jointly provided by Global Education Group and Kidney Academy.
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.
- Upon completion of the educational activity, participants should be able to:
- Understand the coding/documentation compliance requirements.
- Review basic guidelines from AMA and CMS for Evaluation and Management Documentation regarding physician patient visits updated 2021.
- Understand the concept for “global packaging”, regarding CPT coding and modifiers.
- Verbalize the definition of the ICD-10 diagnostic history and how unspecified statements may result in non-payment.
- Outline the key elements in the patient’s documentation to capture the appropriate ICD-10 diagnostic assessments.
- Define of complication of coding for Thoracic Central Vein Obstruction (T-CVO) (in Module 7) and Dialysis Access Steal Syndrome (DASS) (in Module 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.
- Review Office of Inspector (OIG) audit results for Medicare and ESRD.
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
- Pre-Test For Module 12 With 20 Multiple Choice Questions
- Introduction To CPT and ICD 10 Coding for Dialysis Access
- Current Upgrading CPT and ICD10
- Surgical Global Package
- ICD -10-Cm Coding Guidelines
- Coding For Dialysis Access Complications
- ICD-10 Coding for Chronic Conditions (Co-Morbidity)
- CPT Codes Categories
- CPT Codes for Hemodialysis and Peritoneal Dialysis
- Coding and Documentation Compliance
- Post-Test For Module 12 with 20 Multiple Choice Questions
- Take a Short Survey Print Your Certificate (14/20 correct Answers required)
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