Billing tasks can become much easier if you know your codes. But how can you do that with so many procedures, complex situations, coverage exceptions, and rules? It is common knowledge that nephrology focuses on diagnosing and treating kidney diseases. It has evolved into a major internal medicine specialty and continues to grow due to the rise of chronic kidney diseases (CKD) and end-stage renal diseases (ESRD) in Americans.
Hence, this field has high claim denial rates. If you work in Nephrology, you are in the right place. With our list of the most common nephrology CPT codes for 2024, we will improve your coding accuracy and guide you toward success. But first, let’s explore the primary billing problem of this specialty.
The “Nephrology” Problem
Nephrology specialists understandably don’t have the time to become coding experts. According to DaVita Newsroom’s article titled ‘Who Will Inspire the Next Generation of Nephrologists?’, nephrology fellowship positions have decreased by 10% in 2024 compared to last year, affecting medical academic centers the most.
Nephrologists are already stretched thin due to this critical shortage. On top of that, emerging trends and treatments, changing regulations, and coding updates create additional burdens. As a result, claim denials are a common issue in this field.
Most Used CPT Codes for Nephrology
Here are some of the most frequently used nephrology CPT codes of 2024.
Nephrology CPT Codes for Hemodialysis Procedures
CPT Code 90935 – Hemodialysis with E/M
This nephrology CPT code addresses hemodialysis – a process to remove blood’s impurities via a machine. Nephrology specialists use code 90935 to claim reimbursement for a single session of hemodialysis and any evaluation or management (E/M) service they have provided related to it on the same day.
CPT Code 90937 – Hemodialysis with a Re-Evaluation
This nephrology CPT code is more or less the same as 90935, which addresses hemodialysis. However, where CPT code 90935 is used when only one evaluation is performed during a patient’s hemodialysis, nephrologists use the 90937 CPT code when they re-evaluate a patient during their dialysis.
CPT Code 90940 – Vascular Access Monitoring
The 90940 CPT code addresses a monitoring process of a patient’s blood. Nephrology specialists use this code to report that they have observed a patient’s vascular access site to make sure it stays open to prevent blood clots. This process may not seem much, but it is essential for an effective dialysis treatment.
Nephrology CPT Codes for Various Dialysis Services & Procedures
CPT Code 90945 – Pre-Dialysis Evaluation
This nephrology CPT code reports a pre-dialysis evaluation to the payer. In simple words, billing experts use the 90945 CPT code to specify that a provider has evaluated a patient to choose the most appropriate method for their dialysis (excluding hemodialysis).
CPT Code 90947 – Dialysis with Multiple Evaluations
You can use this code to address dialysis with multiple evaluations. To put it simply, the 90947 CPT code highlights that a patient underwent repeated assessments by a physician during the dialysis process. These evaluations may or may not result in a physician making several adjustments to the patient’s treatment plan.
Let us give you a more specific example. Billing experts can report this nephrology CPT code for renal replacement therapy – a special type of dialysis performed over 24 hours on critical patients who cannot tolerate regular dialysis.
Nephrology CPT Codes for End-Stage Renal Disease Services
The nephrology CPT codes in this category refer to full and partial monthly dialysis care services for ESRD patients in the following age groups.
- Under 2 years
- 2 to 11 years
- 12 to 19 years
- 20 and above
Each code addresses the frequency of patient-doctor visits or the services tailored to patients’ ages. Here are some of the most popular nephrology CPT codes for ESRD services.
CPT Codes 90960 to 90962 – Care Services for ESRD Patients (Aged 20 & Above)
Nephrology CPT codes ranging from 90960 to 90962 refer to monthly care services provided to patients with end-stage renal disease (ESRD) – a terminal illness. So, what is the difference? The distinction lies in the number of times healthcare providers see ESRD patients aged 20 or older for these services.
| CPT Code | Description |
|---|---|
| 90960 | Specifies a healthcare provider managing all the monthly care services for an ESRD patient. This code is used to notify payers that a nephrologist has seen a patient four or more times during the month. |
| 90961 | It is similar to CPT code 90960. However, it is used when a provider sees a patient two to three times to provide monthly care services. |
| 90962 | This code reports that a nephrologist has only visited their ESRD patient once to provide monthly care services. |
CPT Code 90966 – Care Services for a Home Dialysis Patient (Aged 20 & Above)
This CPT code for nephrology covers all the physician care services for a home dialysis patient. In simple terms, nephrologists use the 90966 CPT code to claim reimbursement for providing in-home care to an ESRD patient for a month.
CPT Codes 90967 to 90970 – Dialysis Care Services Management
These CPT codes for nephrology cover the care services provided to ESRD patients undergoing dialysis. Each CPT code refers to a different age group. Nephrologists use these codes to bill insurance companies for providing dialysis care to a patient for less than a month. They tailor these care services to the needs of patients and their age groups.
| CPT Code | Description |
|---|---|
| 90967 | Covers the management of dialysis care for an ESRD patient under 2 years old. |
| 90968 | Reports the dialysis care management of ESRD patients between 2 and 11 years old for less than a month. |
| 90969 | Specifies dialysis care management for ESRD patients aged between 12 and 19 for less than one month. |
| 90970 | Also covers dialysis care management for less than a month but for ESRD patients aged 20 or above. |
Nephrology CPT Codes for Other Dialysis Procedures
CPT Code 90989 – Full Dialysis Training Course for Self-Care
This nephrology CPT code addresses a complete training program for managing self-care dialysis treatment. Nephrologists use CPT code 90989 to indicate that they have trained a patient or a helper to perform full dialysis at home.
CPT Code 90993 – Partial Dialysis Training Course for Self-Care
CPT code 90993 also points towards a dialysis treatment program but for individual sessions. Hence, nephrologists use this code to specify that they have trained a patient or their helper to perform dialysis, but only partially. The full course is still in progress. As a result, this code is generally used to report each self-care and dialysis treatment session to insurance companies.
CPT Code 90997 – Hemodialysis with Extra Medical Supervision
This nephrology CPT code translates a hemodialysis process that requires extra medical supervision. Billing experts use the 90997 CPT code to notify a payer that a nephrologist has removed substances from a patient’s blood through a charcoal or resin filter (similar to an artificial kidney). This code is also used to highlight a dialysis procedure in life-threatening situations like drug overdose.
CPT Code 90999 – Miscellaneous Dialysis Procedures
This is a general CPT code for nephrology. It covers all unique dialysis treatments. In short, you can use the 90999 CPT code to report those services and procedures that don’t have a specific code.
Bottom Line
Coding is an important part of medical billing and, most of the time, a major reason for claim denials. Successful practices enjoy higher clean claim rates due to accurate coding. So, if you want to join their ranks, you should improve your coding accuracy by staying updated on the latest nephrology CPT codes or hiring a coding expert. Want to know the most cost-effective and time-efficient option? Consider Outsourcing! Several top billing companies, including MediBill MD, offer coding as part of their nephrology billing services. So, if you don’t have the time or the confidence to translate your services into medical claims, assign this task to a reputable company and improve your revenue.
