Article Detail - JE Part B

Renal dialysis procedures, CPT codes 90935, 90937, 90945, 90947, G0491, and G0492, include the Evaluation and Management (E/M) services related to the dialysis procedure and the renal failure. If dialysis and medically reasonable and necessary E/M service unrelated to the dialysis procedure or renal failure are performed by the same provider, on the same date of service, these services may be separately reported.

The National Correct Coding Initiative (NCCI) manual, chapter 11, CMS allows providers to additionally report appropriate E/M CPT codes 99202-99215, 99221-99223, 99238-99239, and 99291-99292 with modifier 25 if performed on the same date of service as the dialysis procedure. Per CMS payment policy, any E/M service related to the renal failure (e.g., hypertension, fluid overload, uremia, electrolyte imbalance) or to the dialysis procedure and that is performed on the same date of service as the dialysis procedure shall not be reported separately, even if performed at a separate patient encounter. E/M services for conditions unrelated to the dialysis procedure or renal failure may be reported separately with modifier 25 only if they cannot be performed during the dialysis session.