Saturday, September 24, 2016

How to US Modifier V5 -V9 - ESRD modifiers

Dialysis adequacy, infection and vascular access reporting 

Effective for dates of service on and after July 1, 2010, renal dialysis facilities will require new quality data reporting for:

Dialysis adequacy.


Vascular access.

Under the PPACA providers must submit claims as follows:

Claims with DOS prior to October 1, 2009 must follow the previous timely filing guideline.

Claims with DOS October 1, 2009 – December 31, 2009 must be filed by December 31, 2010.

Claims with DOS January 1, 2010, and forward must be filed within one calendar year of the DOS.

The new data reporting will allow the CMS to implement an accurate quality incentive payment for dialysis providers by January 1, 2012, as required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) section 153c.

ALL end stage renal disease (ESRD) claims will require on the claim level:

o  Value code D5 – result of the last Kt/V reading
o  Occurrence code 51 – date of last Kt/V reading

No Kt/V test done –provider must attest that no test was performed by reporting the value code D5 with a 9.99 value and do not report the occurrence code date on the claim

ALL ESRD claims will require on the claim level:

o   Modifier V8 OR 
o  Modifier V9 

ALL ESRD hemodialysis claims will require for vascular access ESRD hemodialysis patients under Revenue code 821:

o  Modifier V5 
o  Modifier V6 
 o Modifier V7 

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