Chapter 4: Coding Procedures for Dialysis Access

Benefits from reading and understanding dialysis coding maximize financial reimbursement, while eliminating potential jailtime for fraudulent billing. ESRD patients generate high procedure volumes and complex claims across several service hospital outpatient lines making dialysis access a prime target for payer scrutiny and enforcement.  For each $1.00 the Department of Justice invests in fraud cases, they return an average of $5.59 back to the government. As these procedures have high reimbursement rates, the return on investment for an access case is better than other procedures. In recent years, most of the cases involving dialysis access have been Qui Tam (whistleblower) cases, and the publicity surrounding these cases is sometimes enticing to providers looking to blow the whistle on either a previous employer or competitor.

Current trends amplify the stakes are that ESRD patients constitute a small fraction of beneficiaries but consume a large share of Medicare spending. Dialysis access interventions (angioplasty, thrombectomy, stent placement, surgical revision and new innovative procedures) are high-cost and frequently repeated procedures.

Chapter content coming soon.