Transcript Billing In PCRRT

Billing In PCRRT
Timothy E. Bunchman
Professor Pediatrics
Paying attention to detail
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Costs/Charges associated with
PCRRT
Hospital
Equipment
Pharmacy
Nursing
PICU
Dialysis
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Physician
Critical Care
Nephrology
? Surgery
Hospital Cost
Equipment
• Equipment
– Machinery
• Depreciation over time
– Disposables
• lines
• hemofilters
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Hospital Cost
Pharmacy
• Solutions
– Industry made
– Pharmacy produced
• Change in drug dosing due to increase
clearance
• TPN losses
• Heparin, Citrate, Calcium
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Hospital Cost
Nursing
• Isolated Critical Care Programs
– start up time
– continuous care time
• Programs supported by both Dialysis staff
and Critical Care staff
– start up time (done by dialysis staff)
– continuous care time (done by Critical Care
staff)
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Physicians Charges
• Isolated Critical Care programs
– Access placement
– Prolonged constant attendance
– Dialysis Charge
• Programs by both Dialysis and PICU
– Access placement (PICU charge)
– Prolonged constant attendance (PICU charge)
– Dialysis Charge (Nephrology Charge)
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CPT codes for Physician Charges
• Access Placement
– 36488 (< 2 yrs of age)
– 36489 (> 2 yrs of age)
• Prolonged Constant Attendance
– 99356 initial 30-74 minutes
– 99357 each additional 30 minutes and can
include the last 15 minutes of the visit for the
day
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CPT codes for Physician Charges
• Dialysis Charges
Hemodialysis
- 90935 with single evaluation of patient
- 90937 with multiple evaluations of patient
CRRT/Peritoneal Dialysis
- 90945 with single evaluation of patient
- 90947 with multiple evaluation of patient
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How can Nephrology affect
(positively) PICU admissions
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More patients on CRRT means
more PICU patients
80
70
60
50
Pt #
PD
HD
CRRT
Total
40
30
20
10
0
1992 1993 1994 1995 1996 1997 1998 1999
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Conclusion
• Unfortunately, billing is an issue that cannot
be ignored
• CRRT is a modality that serves patients well
• PCRRT has potentially hidden avenues that
will allow for capturing of charges in order
to support a PCRRT program
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