Nephrology is a highly specialized field focusing on the diagnosis and treatment of kidney-related conditions including chronic kidney disease (CKD), acute kidney injury (AKI), hypertension, end-stage renal disease (ESRD), and dialysis care. With such a complex and regulated specialty, accurate and compliant billing is essential for financial success.

Nephrology billing involves frequent visits, complex procedure codes, bundled dialysis services, care coordination, and strict Medicare compliance — especially for ESRD patients. Incorrect coding or documentation can lead to claim denials, payment delays, or Medicare audits.

At Progressive RCM, we provide tailored nephrology medical billing services that help practices improve collections, reduce administrative burden, and ensure regulatory compliance — so providers can focus on patient outcomes, not paperwork.

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Unique Billing Challenges in Nephrology

1. Dialysis Billing and Bundling

Nephrologists often oversee inpatient, outpatient, and home dialysis, all of which have unique billing structures. Medicare bundles services like:

• Monthly Capitation Payment (MCP)

• Related lab tests and medications

• Patient education sessions

Incorrect bundling can lead to denials or underpayments.

2. Monthly Capitation Payments (MCP)

Billing for ESRD patients under MCP requires:

• Accurate patient assignment

• Full documentation of 4+ visits per month

• Correct use of CPT codes 90951–90970

MCP claims are frequently denied due to missing documentation or visit frequency issues.

3. Medicare and MAC Regulations

Medicare is the primary payer for ESRD patients. Providers must follow strict CMS ESRD guidelines, LCD/NCD rules, and MAC jurisdiction policies to avoid audits and revenue loss.

4. Multiple Places of Service

Nephrologists deliver care in clinics, hospitals, dialysis centers, and SNFs. Each requires correct POS codes, modifiers, and billing formats.

5. High Patient Volume with Comorbidities

Patients with CKD or ESRD typically have hypertension, diabetes, cardiovascular disease, or other comorbidities. Accurate coding for each condition impacts medical necessity, reimbursement, and risk adjustment.

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Common CPT, HCPCS, and ICD-10 Codes in Nephrology Billing

✅ CPT Codes:

• 90951–90970 – Monthly ESRD-related services (MCP codes)

• 82040 – Serum albumin

• 82565 – Creatinine; blood

• 99221–99223 – Initial hospital visit

• 99231–99233 – Subsequent hospital visit

• 99406–99409 – Smoking cessation counseling

• 99601–99602 – Home dialysis training (by RN)

✅ HCPCS Codes:

• G0308–G0315 – ESRD-related visits for home dialysis

• E1629 – Dialysis chair

• A4651–A4657 – Dialysis supplies

• J1756 – Iron sucrose injection

• J2505 – Epoetin alfa injection (for anemia in ESRD)

✅ ICD-10 Codes:

• N18.1–N18.6 – CKD stages 1–5 and ESRD

• Z99.2 – Dependence on renal dialysis

• N17.9 – Acute kidney failure, unspecified

• I12.9 – Hypertensive CKD with stage 1–4 CKD

• E11.22 – Type 2 diabetes with diabetic CKD

• Z49.01–Z49.32 – Encounter for dialysis care

• D63.1 – Anemia in chronic kidney disease

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Our Specialized Nephrology Billing Services

At Progressive RCM, we provide end-to-end billing support for nephrology practices, dialysis centers, and multi-provider groups managing chronic kidney patients.

✅ Patient Eligibility & Authorization

• Confirm insurance eligibility for dialysis, lab work, and chronic care

• Verify Medicare ESRD status and secondary coverage

• Obtain pre-authorizations for imaging, access placement, or medications

✅ Accurate Coding and Documentation

• Assign correct CPT, ICD-10, and HCPCS codes

• Ensure documentation supports MCP billing and hospital rounding

• Use proper modifiers for place of service, telehealth, or multiple providers

✅ MCP and Dialysis Claims Management

• Submit accurate MCP claims (90951–90970)

• Track dialysis encounters and visit counts per month

• Bill for home dialysis training, nutrition counseling, and more

✅ Inpatient and Hospital Visit Billing

• Code initial consults, subsequent visits, and discharge summaries

• Manage care coordination across hospitals and dialysis centers

• Apply POS codes and NPI matching to prevent denials

✅ Denial Prevention and Appeals

• Monitor denial reasons: MCP errors, bundling issues, incorrect ICD-10 codes

• Resubmit claims with supporting labs, notes, or provider signatures

• Appeal non-covered dialysis-related services when appropriate

✅ Telehealth and Chronic Care Support

• Bill for remote CKD management using modifier 95 or POS 10

• Manage chronic care codes 99490–99489

• Submit claims for virtual nutrition counseling, smoking cessation, and medication management

✅ Reporting and Analysis

• Monthly financial reports

• AR aging

• Dialysis-related claim trends

• Reimbursement rates by payer

• First-pass claim acceptance rate

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Why Choose Progressive RCM for Nephrology Billing?

✅ Nephrology Billing Experts
Our certified coders understand the nuances of CKD, dialysis, hypertension, and anemia billing, along with CMS ESRD policies.

✅ Full Coverage of ESRD Regulations
We comply with MAC guidelines, LCD policies, and ESRD Quality Incentive Programs (QIP) to keep your practice compliant and audit-ready.

✅ Integrated Billing for All Settings
Whether you bill from hospitals, dialysis centers, clinics, or home settings, we manage claims accurately for every POS.

✅ Revenue-Driven Results
We improve first-pass claim rates, reduce AR days, and help nephrology providers get paid faster for every visit and procedure.

✅ Real-Time Reporting and Dedicated Support
We provide personalized account managers and custom dashboards so you’re always informed about revenue performance.

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KPIs We Track for Nephrology Practices

• MCP visit completion rate

• Average reimbursement per dialysis patient

• ESRD claim approval rate

• Days in AR by payer

• Denial rate by CPT and ICD-10

• Monthly revenue per provider

• Medicare vs. commercial collections

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Final Thoughts

Nephrology billing is specialized, time-sensitive, and compliance-driven. From managing MCP claims and dialysis codes to tracking complex comorbidities and Medicare audits, every part of your billing process must be precise.

At Progressive RCM, we support nephrologists with expert billing, detailed coding, and proactive revenue management — helping your practice thrive while ensuring top-tier care for kidney patients.