RENAL FAILURE

Sassyaugustchyck@yahoo.com

I HAVE A QUESTION. I HAVE A PATIENT THAT HAD COMPLICATION (HEMORRHAGE AND MALFUNCTION DUE TO STENOSIS) OF ARTERIOVENOUS FISTULA. NURSING IS MONITORING THE SITE. PROBLEM IS, PATIENT HAS I50.22, I120, N186 AND THAT'S PRETTY MUCH IT. I KNOW THAT THERE CAN NOT BE A DUPLICATION OF SERVICES AND NURSING IS MONITORING THE CHF BUT WHEN YOU FOLLOW GUIDELINES NOW, I CAN'T PUT THE I5022 WITHOUT THE HTN NOW. PLEASE HELP...

kcarter

Hypertensive heart disease with ESRD and heart failure should be coded to I13.2, followed by I50.22 and N18.9 per coding guidelines. Your POC would need to indicate the home health focus of care is the CHF not the renal failure to avoid the overlap in service. I am assuming that you are referring to dialysis.

kcarter

Services that are covered under the ESRD program and are contained in the composite rate reimbursement methodology, including any service furnished to an ESRD beneficiary that is directly related to that individual's dialysis, are excluded from coverage under the Medicare home health benefit. However, to the extent a service is not directly related to a patient's dialysis, e.g., a nursing visit to furnish wound care for an abandoned shunt site, and other requirements for coverage are met, the visit would be covered. Within these restrictions, beneficiaries may simultaneously receive items and services under the ESRD program at home at the same time as receiving services under the home health benefit not related to ESRD.
(Medicare Benefit Policy Manual, Chapter 7 - Home Health Services, 80.5 - Services Covered Under End Stage Renal Disease (ESRD) Program)