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February 2013

Billing for dialysis services, ESRD clarified

Under current BCBSM policy, condition codes are required for all revenue codes when billing for dialysis services. Beginning
April 1, 2013, claims for dialysis services billed without a condition code, with the exception of revenue code 0880, will be returned for correction. This applies to both hospitals and freestanding dialysis centers.

The following chart reflects valid revenue code and condition code combinations.

Revenue codes and nomenclature

Condition codes

71

72

73

74

76

Full care in unit

Self-care in unit

Self-care training

Home

Back-up
in-facility dialysis

0821

Hemodialysis/composite or other rate

X

X

X

X

X

0831

Peritoneal dialysis/ composite or other rate

X

 

 

 

 

0841

CAPD/composite or other rate

 

 

X

X

 

0851

CCPD/composite or other rate

 

 

X

X

 

0880

Miscellaneous dialysis - general

 

 

 

 

 

0881

Ultrafiltration

X

 

 

 

 

For complete billing instructions, please check your provider manual on web-DENIS.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
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