Update: Billing End Stage Renal Disease (ESRD) Related Services for Transient Dialysis Patient
The November 2004, Communiqué contained a MLN Matters article published by the Centers for Medicare & Medicaid Services (CMS) titled, "Payment for Outpatient End Stage Renal Disease (ESRD) Related Services." The purpose of the article was to assist physicians and practitioners billing for outpatient ESRD-related services.
The article advised physicians and practitioners to bill with the unlisted dialysis Current Procedural Terminology (CPT) code 90999, when managing outpatient ESRD-related services for transient dialysis patients (patients traveling away from home - less than full month). HCPCS codes G0324-G0327 were not appropriate for these situations, as the original narrative descriptions for G0324-G0327 contained the words "home dialysis."
WPS Medicare has recently been working with CMS to clarify the original instructions, and to ensure proper billing for these situations. CMS recently clarified to WPS Medicare that the unlisted dialysis code (90999) was only intended to be used for Outpatient ESRD-related services (transient patients) on a temporary basis. CMS published Change Request (CR) 3595, "Emergency Update to the 2005 Medicare Physician Fee Schedule Database," after the MLN Matters article that clarified "home dialysis" should not be included in the narrative descriptions of these codes. Therefore, in lieu of billing 90999 for these situations, physicians and practitioners managing Outpatient ESRD-related services for transient dialysis patients (patients traveling away from home - less than full month) can utilize HCPCS codes G0324-G0327 accordingly.
CR 3595 provided the following narrative descriptions for G0324-G0327:
G0324-End stage renal disease (ESRD) related services less than full month, per day; for patients under two years of age
G0325-End stage renal disease (ESRD) related services less than full month, per day; for patients between two and eleven years of age
G0326-End stage renal disease (ESRD) related services less than full month, per day; for patients between twelve and nineteen years of age
G0327-End stage renal disease (ESRD) related services less than full month, per day; for patients twenty years of age and over
To view a copy of CR 3595, please refer to the CMS Website below:
http://www.cms.hhs.gov/transmittals/downloads/R414CP.PDF 
100KB
WPS Medicare does not routinely require supporting documentation (medical records) for G0324-G0327 on a pre-payment (claim level) basis. However, the medical records should be available to WPS Medicare upon request, and should include the following:
- Supporting and legible documentation for the service(s) provided
- Identity of the patient (e.g. name, address, Medicare number)
- Dates on which the billing provider was responsible for the beneficiary's outpatient ESRD-related services
- The name of the provider who was responsible for (supervising) the beneficiary's outpatient ESRD-related services during this time
Page Last Updated: Tuesday, 15-Jul-2008 10:45:04 CDT
