Showing posts with label ESRD modifiers. Show all posts
Showing posts with label ESRD modifiers. Show all posts

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.

Infection.

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 

For additional information please visit;
http://www.cms.gov/MLNMattersArticles/downloads/MM6782.pdf

Friday, June 4, 2010

CB, AX, CD AND G6 - End Stage Renal Disease (ESRD) Modifiers

End Stage Renal Disease (ESRD) Modifiers

CB Services ordered by a dialysis facility physician as part of the ESRD beneficiary's dialysis benefit.
AX Item furnished in conjunction with dialysis services.
CD AMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable
CE AMCC test has been ordered by an ESRD facility or MCP physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity
CF AMCC test has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable
EJ Subsequent claims for a defined course of therapy, e.g., EPO, sodium hyaluronate, infliximab.
G1 Most recent URR reading of less than 60
G2 Most recent URR reading of 60 to 64.9
G3 Most recent URR reading of 65 to 69.9
G4 Most recent URR reading of 70 to 74.9
G5 Most recent URR reading of 75 or greater
G6 ESRD patient for whom less than seven dialysis sessions have been provided in a month.

Most read cpt modifiers