Nephrology Medical Billing Services for Kidney Disease & Dialysis Practices in the USA
Kidney care and dialysis billing services for clinics and hospitals.
Specialty highlight
99%
Built around payer rules, documentation requirements, and coding nuances.
ESRD MCP Accuracy
99%
Clean Claim Rate
96%
Nephrology Billing Services for CKD, ESRD & Dialysis Practices
Nephrology billing is highly specialized, revolving around the management of Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD), with a significant focus on dialysis services. This area is governed by a unique set of complex regulations, including the ESRD Prospective Payment System (PPS) and specific coding requirements for dialysis-related services. Our nephrology billing service is designed to navigate this intricate landscape, ensuring accurate coding for all office visits, procedures, and especially the monthly capitation payment (MCP) for dialysis care, maximizing your practice's revenue while maintaining strict compliance.
ESRD Monthly Capitation Payment (MCP) Billing
Precise MCP coding (90951-90970) based on patient age, dialysis modality, and monthly face-to-face visit count, ensuring every ESRD patient is billed at the correct capitation level.
Vascular Access Procedure Billing
Expert CPT coding for fistula creation, graft placement, thrombectomies (36831), angioplasty (36902), and fistulograms, with correct medical necessity documentation and payer-specific prior authorization.
CKD Staging & Chronic Disease Management
Accurate ICD-10 staging for CKD (N18.1-N18.6) with comorbidity coding, E&M service billing for complex nephrology visits, and CCM program billing for eligible chronic kidney disease patients.
Home Dialysis Training & Peritoneal Billing
Specialized billing for peritoneal dialysis (90945-90947), home hemodialysis training programs, and CAPD/CCPD supply billing, ensuring all home dialysis services are captured and compliant with ESRD PPS.
Nephrology Billing Challenges That Affect Your Dialysis Revenue
ESRD billing operates under one of the most regulated reimbursement systems in Medicare. These are the compliance gaps and coding errors that most often cost nephrology practices their revenue.
- Mastering the ESRD Prospective Payment System (PPS) and its impact on dialysis billing.
- Accurately coding for monthly capitation payments (MCP) for in-center and home dialysis.
- Billing for dialysis-related procedures and surgeries, such as vascular access creation and management.
- Ensuring proper coding for CKD staging and related comorbidities.
- Managing the complex coding requirements for home dialysis training and support.
- Certified nephrology coders with deep expertise in ESRD regulations, CKD management, and dialysis billing.
- Precise coding for Monthly Capitation Payments (MCP) for all dialysis modalities (in-center, home, peritoneal).
- Expertise in billing for vascular access procedures, including fistulograms, angioplasty, and thrombectomies.
- Accurate coding for CKD staging and all associated comorbidities to ensure proper risk adjustment.
- Proactive management of documentation to support the level of care for dialysis patients.
- Detailed support for home dialysis training and supply billing.
How We Protect Nephrology Revenue Across All Dialysis Modalities
Our nephrology billing workflow is purpose-built for the ESRD PPS, MCP coding rules, and vascular access billing complexities that define kidney care revenue cycle management.
ESRD Monthly Capitation Payment Coding
Precise MCP billing (90951-90970) with visit-count verification, correct age-based code selection, and modality-specific billing for in-center hemodialysis, home hemodialysis, and peritoneal dialysis.
Vascular Access Procedure Billing
Expert CPT coding for AV fistula and graft creation, thrombectomy (36831), angioplasty (36902-36907), fistulogram, and stent placement with correct bundling rules and medical necessity documentation.
CKD Staging & Comorbidity Coding
Accurate ICD-10 staging for CKD Stage 1-5 and ESRD (N18.1-N18.6), with systematic comorbidity coding for hypertensive CKD (I12.x), diabetic nephropathy (E11.65), and anemia of CKD (D63.1).
Home Dialysis Training & Peritoneal Billing
Specialized coding for peritoneal dialysis services (90945-90947), CAPD/CCPD training programs, and home dialysis setup, ensuring full reimbursement under Medicare's ESRD Prospective Payment System.
Renal Transplant Pre & Post-Care Billing
Complete billing for transplant evaluation, living donor workup, immediate post-transplant care, and long-term immunosuppression management, ensuring transplant-related services are fully captured.
How Precise Nephrology Coding Protects Your Dialysis Reimbursement
From MCP visit-count verification to vascular access intervention sequencing, these are the precision areas where nephrology billing accuracy directly impacts your reimbursement.
- Monthly capitation coding based on patient age and the number face-to-face visits per month.
- Distinguishing between outpatient dialysis services and inpatient nephrology consultations.
- Coding for vascular access procedures, including thrombectomy (36831) and angioplasty (36902).
- Correct coding for peritoneal dialysis-related services and supplies.
Incorrect coding of MCP services based on the number of visits.
Lack of documentation to support the level of ESRD care provided.
Bundling of services included in the MCP.
Coding for access procedures without supporting medical necessity.
Errors in patient status (e.g., outpatient vs. inpatient) for dialysis billing.
Nephrology CPT & ICD-10 Codes for ESRD, CKD & Dialysis Billing
Our nephrology coders are trained across the complete ESRD, CKD, and dialysis CPT and ICD-10 code sets, including vascular access procedures and transplant-related coding.
CPT
90960 (ESRD, 4 visits/month), 99214 (Office Visit), 36831 (Thrombectomy, Graft), 50300 (Renal Transplant), 93990 (Access Flow Study)
ICD-10
N18.6 (ESRD), N18.32 (CKD Stage 3b), I12.9 (Hypertensive CKD), Z99.2 (Dependence on Renal Dialysis), T82.7XXA (Complication of Vascular Access)
Frequently Asked Questions
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Revenue cycle services for this specialty
Connect specialty-specific billing needs with the core MI MedCare services that keep claims accurate, compliant, and moving.
Medical Billing
End-to-end medical billing services that improve claim acceptance and accelerate reimbursements.
Revenue Cycle Management
Complete RCM solutions covering patient intake, billing, payments, and financial reporting.
Medical Coding
Certified coders ensure accurate ICD-10, CPT, and HCPCS coding for compliant claims.
Credentialing
Provider credentialing and payer enrollment to get your practice contracted faster.
Eligibility Verification
Insurance eligibility and benefits verification before services are delivered.
Denial Management
Identify denial causes, correct errors, and recover lost revenue efficiently.