At Apex MedPro, we understand the unique workflow requirements of Nephrology practices. We have worked closely with hundreds of Nephrologists to identify and build features tailored to their major pain points. Our easy-to-use solutions, such as revenue cycle management and medical billing & coding services, solve complex problems and help our Nephrology practices meet their workflow requirements.
We provide professional medical billing and coding services for specialty practices. It can be challenging to stay on top of all the documentation and technical language required for each specialty, but our team is dedicated to making sure everything is coded and billed correctly. Renal patients often require several treatments. These are extensive and focus is needed to avoid denials. Did you know that dialysis is not payable with follow up visits, only essential care, provided that is billed using appropriate modifiers? Or that a provider must be present during a dialysis session oversight to receive compensation? Our years of experience
Nephrology is the field of medicine that deals with the diagnosis and treatment of kidney diseases. These diseases are often caused by other systemic disorders, such as autoimmune diseases or diabetes mellitus. They can also lead to systemic complications, such as hypertension and osteodystrophy. Electrolyte imbalances, acidosis, kidney stones, polycystic kidneys, vasculitis, proteinuria, and hematuria can all be associated with kidney dysfunction. In the most severe cases, chronic renal failure may require dialysis or a kidney transplant.
In this blog post, we will talk about some common mistakes in Nephrology Billing Services. Let’s find out common mistakes first before we have to find out how to avoid them.
Submitting uncleared diagnosis:
There is a greater emphasis on being specific with diagnoses when coding under ICD-10 standards. This is largely due to the increased risk of denial for practices that are not specific enough in their coding.
Failed to show the documentation described the relationship between the diseases:
When coding for multiple diseases, it is crucial to have documentation present that links or suggests a cause between the diseases. Oftentimes, certain medical conditions have to be coded together. For example, if a patient has hypertension and chronic kidney disease, it is common to see coding for the two diseases done separately. However, if the documentation shows that the patient actually has renal hypertension, which is causing the chronic kidney disease, then the two conditions should be linked together in the code.
Not Submitting proper Codes
Codes that are missing specificity (fourth, fifth, or sixth digits) are often denied because specificity is so important in coding today. So properly submitted codes never get denied. You need some professional help to make it submitted correctly.
Some useful tips to prevent denials in your Nephrology Practice.
- Hypertension is no longer classified as benign, malignant, uncontrolled, or controlled.
- Chronic kidney disease (CKD) is a progressive condition that can eventually lead to renal failure. As such, it is important to document the stage of the disease when coding for it.
- If acute renal failure is present, it must be stated.
- Diabetes mellitus is no longer classified as uncontrolled or controlled.
- When coding for diabetes, you must include the type of diabetes, such as drug or chemical induced, Type 1, Type 2, or due to an underlying medical condition.
- The term “acute pyelonephritis” is no longer used to describe the condition known as acute tubulointerstitial nephritis.
- The term “chronic pyelonephritis” can be changed to “chronic tubulointerstitial nephritis”.
- The specific manifestations of diabetes-related complications, such as chronic kidney disease or nephropathy, should be specified as such, e.g. diabetes chronic kidney disease, and diabetic nephropathy.
As Nephrology Billing and Coding Services continue to evolve and become more complex, many practices find that outsourcing these services is a better option in terms of reducing practice expenses and ensuring greater coding accuracy and fewer denials. Outsourcing to companies that specialize in Nephrology Coding ensures that Nephrology practices use the appropriate specificity when coding claims, which in turn maximizes per code collections and reduces denials.
If you are interested in learning more about Apex MedPro Nephrology Medical Billing Services, please contact us at info@apexmedpro.com or give us a call at +1-877-333-1760. We’d love to hear from you!