Nephrology Billing Services
Nephrology billing is built around dialysis. For patients with end-stage kidney disease, much of a nephrologist's income comes from monthly management payments rather than individual visits. Those payments depend on the patient's age, the number of visits in the month, and how the patient dialyzes.
The same practice may also see patients with early kidney disease, manage hospital consults, and perform biopsies or access procedures. Each of these follows its own rules. Westmont Revenue Partners connects nephrology groups with vetted billing experts who understand nephrology billing, including the monthly dialysis model and the documentation it requires.
Who this is for
- Nephrologists in private practice
- Nephrology groups that round at dialysis centers
- Practices that manage home dialysis patients
- Groups with hospital consult coverage
- Practices that see chronic kidney disease patients
- Nurse practitioners and physician assistants in nephrology
What gets billed
- Monthly end-stage renal disease management
- Dialysis visits billed per session, in certain cases
- Office visits for chronic kidney disease
- Hospital and dialysis facility consults
- Percutaneous kidney biopsy
- Dialysis access procedures
- Care planning and patient education
- Transplant evaluation visits
- Visits for acute kidney injury
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| 99214 | CPT | Established patient office visit at a moderate level |
| 90935 | CPT | Hemodialysis with one physician evaluation |
| 90937 | CPT | Hemodialysis with repeated physician evaluations |
| 90960 | CPT | Monthly dialysis management, age 20 and over, 4 or more visits |
| 90961 | CPT | Monthly dialysis management, age 20 and over, 2 to 3 visits |
| 90962 | CPT | Monthly dialysis management, age 20 and over, 1 visit |
| 50200 | CPT | Percutaneous kidney biopsy with needle |
| 36818 | CPT | Open surgery connecting an artery and vein in the upper arm (cephalic vein transposition) for dialysis access |
| N18.6 | ICD-10-CM | End-stage kidney disease |
| N18.30 | ICD-10-CM | Chronic kidney disease stage 3, unspecified |
| N17.9 | ICD-10-CM | Acute kidney failure, unspecified |
| Z99.2 | ICD-10-CM | Dependence on kidney dialysis |
Note
Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.
Billing challenges in nephrology
Monthly visit counts. The monthly code depends on how many face-to-face visits the patient had and the patient's age. A biller counts documented visits each month before choosing the code.
Timing of monthly claims. Monthly services are generally billed after the month ends or when the patient transfers. A biller tracks transfers and hospital stays so claims are not duplicated.
Medicare dialysis rules. Medicare has its own coverage, enrollment, and coordination rules for dialysis patients. These can affect who pays first. A biller verifies coverage order early and follows current updates.
Home dialysis. Home patients use separate monthly codes and have different visit requirements. A biller confirms the modality so the correct family is used.
Hospital and dialysis services on the same day. Overlap with inpatient care needs careful review. A biller checks dates and places of service to prevent denials.
CKD staging and diagnosis. Payers look for accurate CKD stage and cause. A biller works with providers so labs and diagnoses agree.
Access procedures. Procedures to create or maintain dialysis access follow their own bundling rules. A biller reads the operative note and applies the right code and modifiers.
How Westmont can help
- Matching you with vetted billing experts experienced in nephrology and dialysis billing
- End-to-end revenue cycle support, including monthly dialysis claims
- Denial management for visit count and overlap issues
- Credentialing support for new nephrologists and facility privileges
- Reporting that tracks monthly dialysis claims by facility
Frequently asked questions
How does monthly dialysis billing work?
For many end-stage renal disease patients, the nephrologist bills one monthly code instead of billing each visit. The code depends on patient age, the number of face-to-face visits, and sometimes the dialysis type. Visits must be documented. A biller counts the visits each month and selects the matching code.
What happens when a dialysis patient is hospitalized or transfers?
The monthly claim may need to be split or adjusted based on dates, and different codes may apply. Payers have rules about which provider can bill. A biller tracks admissions and transfers so claims are not duplicated or missed. Check current payer and Medicare guidance for each case.
Is a kidney biopsy billed separately?
Yes. A percutaneous kidney biopsy has its own procedure code, and imaging guidance and pathology may be billed separately by the relevant providers. Documentation should show the indication and technique. A biller reviews the note to be sure the claim matches.
Why do nephrology claims get denied?
Common causes include visit count mismatches, overlapping hospital dates, coverage order errors, and diagnoses that do not support the service. A biller checks these before submission and works denials promptly.
Should a nephrology group outsource billing?
It may help when monthly dialysis claims, facility rounds, and consults make tracking hard. Westmont does not submit claims itself. We connect you with vetted billing experts, and you decide whether a match fits your group.
Related billing services
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