Coding and Billing for Hemodialysis Access Procedures in the United States

Abstract

Continuous assessment of the process by which care is rendered in order to optimize billing, coding, and ultimately reimbursement is essential. Charge entry staff in each medical practice generate an insurance claim for a given medical provider by linking a diagnosis code with a procedure code and adding modifiers as needed. Claims are typically submitted to the insurance carrier electronically. The appropriateness of this coding translates into timely reimbursement to the provider. Each time a submission is rejected for any reason, the chance of that service ever being paid to the physician decreases significantly. Therefore, the ultimate goal is to generate a claim that is without error and medically appropriate and correctly describes the intervention. This chapter provides an overview of coding and billing for hemodialysis access procedures in the United States and should be used only as a guideline for the physician and coder since each insurance payer has their own rules and regulations.