Nephrology billing guidelinesNephrology is a medical specialty that focuses on the diagnosis and treatment of kidney-related conditions and disorders. Due to the complicated nature of kidney care, the medical billing and coding process poses challenges for healthcare providers. Consequently, many healthcare practitioners opt to outsource nephrology billing services to specialized medical billing companies.

This blog acts as a guideline to help healthcare providers gain a better understanding of nephrology billing and coding. In addition, some common CPT and ICD10 codes, dialysis billing, and future trends have also been discussed.

Understanding Nephrology Billing 

Nephrology billing and coding are essential financial management skills in the healthcare industry. It is especially useful for delivering kidney-relevant medical services. Generally,  nephrology billing is the process of arranging and invoicing payment management for services regarding kidney care. There are chiefly three steps to the billing process. This includes documentation, verification of insurance information, and filing a claim appeal.

Furthermore, nephrology billing ensures that procedures and diagnoses are properly coded. Efficient billing makes sure that health providers are paid rightfully for their services.

Understanding Nephrology Coding

Nephrology coding refers to the classification of procedures related to kidney care through specific alphanumeric codes. These CPT and ICD-10 codes make communication easy between healthcare providers and payers. For instance, when a nephrologist performs dialysis, there are specific codes implemented. These codes help to accurately document and bill for the provided services. Moreover, these codes ensure that healthcare providers are paid for their services. This, in turn, allows them to remain productive and provide quality care.

Common CPT Codes in Nephrology

Here are some common Current Procedural Terminology (CPT) codes associated with nephrology services:

CPT Codes Explanation
90960 Monthly care management for 20-years old ESRD patients who require four visits.
90961 Like 90960 with visits up to twice or three per month.
90962 Similar to 90960, on a monthly basis.
90999 Health and behavioral assessment for ESRD patients.
90966 Home hemodialysis for ESRD patients 20 years or older, involving physician monitoring.
90969 Managing all dialysis services for 12 to 19 years old, less than a month.
90989 Physician teaches and helps during dialysis, offering counseling as well as self-care teaching.
90967 Daily dialysis therapy services under two with ESRD, less than a month.
90970 20 years or older ESRD patients’ daily dialysis treatment.
90968 Outpatient dialysis services for children between 2 and less than a month.


Common ICD10 Codes in Nephrology


ICD10 Codes Explanation
N18.1  Chronic kidney disease stage 1
N18.2  Chronic kidney disease stage 2 N18.30
N18.6  End stage renal disease
D64.9.  Anemia, unspecified.
N17.0  Acute kidney failure with tubular necrosis
I16.0  Hypertensive urgency


Nephrology Billing and Coding Guidelines for Healthcare Providers

The nephrology billing and coding guidelines comprise a set of rules and regulations. It focuses on providing proper financial management of kidney care services. Here are some key aspects of nephrology billing and coding guidelines:

  • Accurate Documentation
  • Specificity in Code Selection
  • Compliance with Regulations
  • Timely Submission of Claims
  • Continual Training and Education

Accurate Documentation

Medical procedures, diagnoses and services associated with nephrology must be documented appropriately. This involves keeping particular records of patient interactions, test outcomes, and also treatment plans. 

Specificity in Code Selection

It is critical to select the appropriate codes that precisely reflect what they provided. This specificity prevents billing errors and provides the correct levels of reimbursement.

Compliance with Regulations

Nephrology billing and coding must comply with the healthcare laws passed by government agencies. Staying compliant with these regulations helps prevent any legal issues. Additionally, it ensures ethical billing practices.

Timely Submission of Claims

In terms of billing guidelines, claims are supposed to be submitted in a timely manner. Consequently, failure to submit the claim in time may result in delayed payment or even denial of claims. So, healthcare providers should develop optimized claim submission processes.

Continual Training and Education

With new rules and coding updates, continuous training of healthcare staff is a must. This allows the team to keep pace with industry changes while retaining a high level of accuracy.


How is Dialysis Billed?

The billing for dialysis is claimed through a systematic method. It involves picking the right codes and necessary documentation. However, the process of billing can slightly differ due to several factors. This includes:

  • the type of dialysis (hemodialysis or peritoneal dialysis) 
  • the location where it is delivered (in-center, home, or hospital).

Documentation of the Dialysis Session

Nephrologists and healthcare professionals make notes about the session of dialysis. During these sessions, they record essential details such as the type of dialysis administered, the time taken, and any additional services performed. Proper billing involves accurate documentation.

Selection of CPT Codes

Select the correct CPT codes applicable to the nature of the dialysis service delivered.

  • Hemodialysis: 90960-90962
  • Peritoneal Dialysis: 90966-90970
  • Home Dialysis: 90945-90947

Diagnosis Coding with ICD-10 Codes

Use International Classification of Diseases, 10th Edition (ICD-10) codes to indicate the reason for the dialysis. 

  • Z49.01 for encounters involving hemodialysis
  • Z49.02 for peritoneal dialysis encounters


Modifiers (if applicable)

Depending on the situation, apply modifier codes to provide additional information on the context of dialysis. The modifiers may include details such as an emergency case for the given service.

Submission of Claims

Collect the documented information, including the specified CPT and ICD-10 for coding. Then hand over all the claims to an insurance company.

Verification of Reimbursement

Keep an eye on the progress of claims that have been submitted.  Get in touch regularly with payers to ensure prompt processing. Additionally, make sure that the reimbursement you receive is appropriate for the services provided.

By employing these steps and adhering to coding requirements, healthcare providers  ensure appropriate billing for dialysis procedures and, in turn, maximize reimbursement. 

New Trends in Nephrology Medical Billing

Automation and Software Solutions

Nephrology billing services are now embracing specialized software and technological solutions specific to medical bills. Additionally, software tools also automate billing processes. This includes coding, claim submission, and also payment posting. This automation minimizes manual errors and makes processes faster and more accurate.

Telehealth Billing

Telemedicine and remote patient consultations have significantly influenced billing procedures in nephrology. Billing systems are changing to meet the needs for billing and coding for telehealth services. Notably, the increasing value of accurately documenting and coding these remote services is a case in point.

Focus on Data Analytics

Billing companies use data analytics to identify billing patterns and reimbursement trends. This data helps in RCM optimization and identifies opportunities for better financial performance.

Patient-Centric Approaches

Patient-centered billing practices are increasingly becoming a focus in nephrology. This includes open communication of billing processes, financial obligations, and clean invoicing practices.

Outsourcing and Specialization

Outsourcing to a specialized billing company is widely regarded as the best practice for healthcare providers. These companies have a team of professionals with advanced knowledge of nephrology billing. This gives the practice a chance to provide the best patient care and enhance its RCM. 

Value-Based Care Models

With the move towards value-based care, there is a rising emphasis on outcome reimbursement models as opposed to fee-for-service. Nephrology billing is responding to these models. It focuses on the quality of care delivered rather than measuring its quantity.


Medheave: Your Expert Partner in Nephrology Billing Services

  • Nephrology Coding Expertise:  Medheave offers nephrology coding, which includes CPT and ICD-10 codes. This  represents the variety of kidney care services being provided.
  • Optimizing Reimbursement: Medheave seeks to ensure maximum reimbursement through coding skills. Claims are accurately submitted with minimal likelihood of  being delayed or rejected.
  • Timely Claims Submission: The company helps ensure quick billing. Thus minimizes the risks of late payments resulting in a regular revenue stream.
  • Regulatory Compliance: Medheave keeps up with updated healthcare regulations. They adjust the billing process according to standards set by regulatory bodies.
  • Electronic Claims Processing: Our advanced EHR systems and billing software create streamlined processing of electronic claims. 
  • Denials and Appeals Support: The Medheave team helps find reasons, correct errors, and submit appeals. This prevents payment issues from becoming worse.
  • Focus on Patient Care: Outsourcing to Medheave frees healthcare providers from administrative burden. 

Choose Medheave as your reliable partner. Sign up today to get error-free nephrology billing and coding services.

Leave a Reply

Your email address will not be published. Required fields are marked *