Dialysis is quite common in the U.S., as approximately 815,000 Americans live with kidney failure. However, there are only a handful of codes for this treatment. And even those do not specify every type of dialysis. So, what should you do if all the standard codes seem unsuitable for a specific type of service you have performed?
The good news is that there is a code for these unspecified blood purifications, CPT code 90999. But before using it, you should understand all of its billing requirements. Continue reading to effectively apply 90999.
CPT Code 90999 – Description
As you can guess from the intro, CPT code 90999 is the go-to option for all unspecified dialysis services. In simple terms, it is the code nephrologists use to bill for unlisted blood purification treatments. By unlisted or unspecified, we mean all those services that don’t have a specific code.
So, for example, if you have performed an unusual dialysis procedure, you can use 90999 to bill for it. Remember that this code can be used in both inpatient and outpatient settings. The following section will shed more light on the appropriate uses of this code.
Appropriate Use Cases for CPT Code 90999
Many coders don’t understand the appropriate use of CPT code 90999. Just keep in mind that this code should be your last resort. As for its application, you can explore the following examples:
Billing Hemodialysis for a Medicare Beneficiary
It is commonly known that people with chronic kidney disease are at a higher risk of kidney failure. Around 68% of End Stage Renal Disease (ESRD) patients are on dialysis. Usually, healthcare providers use a different code (90935) to report hemodialysis. But what if you are billing for a Medicare beneficiary on behalf of the dialysis center?
Therefore, let’s suppose an older patient with ESRD arrives at a dialysis center. The nephrologist performs the scheduled hemodialysis to purify his blood. This treatment is performed thrice a week, and the facility bills each session with CPT code 90999.
Reporting a Slightly Modified Form of Peritoneal Dialysis
Peritoneal dialysis (PD) has grown in the past 15 years to become a popular kidney replacement therapy in the U.S. Just like hemodialysis, there are codes for standard PD. But you can use CPT code 90999 to bill for its variations, like Continuous Flow Peritoneal Dialysis (CFPD).
Here is an example of that. Let’s consider a middle-aged woman who wants to sustain her leftover kidney function. Therefore, she opts for this type of dialysis and arrives at a hospital. The healthcare provider performs a modified form of this treatment due to her condition and bills it with the 90999 CPT code.
Dialysis via New or Non-Standardized Technology
The dialysis equipment market is growing at an impressive rate. You can also use this code to bill for toxin removal procedures via new technology. Assume a patient is admitted to a hospital after an acute kidney injury. The nephrologist performs dialysis via non-standardized technology to treat the patient. The facility then uses CPT code 90999 to bill for it.
Modifiers to Append with CPT Code 90999
Was the dialysis performed under special circumstances? You can communicate this information by applying the following modifiers to CPT code 90999.
Modifier 59
If you performed this dialysis with another distinct service, append modifier 59 to CPT code 90999 to avoid bundled payment.
Modifier KX
Did you perform more than 3 unspecified dialyses per week for ESRD patients? You should bill the additional session with modifier KX. This modifier will indicate that you can justify the medical necessity of the extra dialysis with documentation.
Modifier CG
Although modifier CG represents “policy criteria applied,” when used by Rural Health Clinics (RHCs), its function is quite different in the case of ESRD dialysis facilities. Its application means that the dialysis sessions beyond the allowed monthly limit do not meet the medical justification required for extra payment.
So, if you cannot justify the medical necessity of dialysis, apply modifier CG to CPT code 90999 to indicate that you are expecting a Medicare denial.
Reimbursement Guidelines for CPT Code 90999
For the timely processing of your claims, follow these reimbursement guidelines specific to CPT code 90999.
Report Unspecified Dialysis Treatments with CPT Code 90999
This code is only applicable to those dialysis procedures that are not specified by conventional codes, for example, 90935-90945. Hence, you cannot use it for standard hemodialysis or peritoneal dialysis. The code covers unlisted techniques or blood purification performed via specialized equipment.
Comply with Billing Frequency Requirements
There is a limit on CPT code 90999. You cannot use it to bill for unlimited dialysis services. However, these set thresholds may differ from payer to payer. For example, Medicare covers three weekly dialysis sessions. Anything beyond that requires the use of modifier KX or CG with the 90999 CPT code.
The use of these modifiers depends on whether you can justify the medical necessity of an additional session or not.
Support your Claims with Complete Documentation
You shouldn’t expect complete payment for CPT code 90999 without proper justification. Insurance payers require a valid reason for reimbursing this code. Therefore, document the following details when billing for an unconventional dialysis:
- Clinical reason for unspecified dialysis
- Patient’s treatment plan, including dialysis frequency
- Justification for more than 3 sessions in a week (if rendered)
- Modifications (if there are any)
- Treatment’s effectiveness and progress
Avoid Basic Mistakes
Finally, avoid basic mistakes, including using CPT code 90999 without verifying other dialysis codes. As we mentioned earlier, this code should be your last choice. Therefore, go through the entire list and use it only if you cannot find anything for the blood purification service you have performed.
Final Thoughts on CPT Code 90999
CPT code 90999 is specifically for other dialysis services. Hence, you cannot use it for billing every other case. It may look simple, but it has specific billing requirements and even a set billing frequency. That’s why many coders hesitate to use it. To clear common confusion, we have covered all the important details of this code, including real-world examples.
But if you are still confused due to the nature of this code, you can seek our help. Our nephrology billing services can help you obtain timely reimbursements for unspecified dialysis services.
