Timothy E. Bunchman Professor Pediatrics

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Presentation transcript:

Timothy E. Bunchman Professor Pediatrics Billing In PCRRT Timothy E. Bunchman Professor Pediatrics

Paying attention to detail bunchman

Costs/Charges associated with PCRRT Hospital Equipment Pharmacy Nursing PICU Dialysis Physician Critical Care Nephrology ? Surgery bunchman

Hospital Cost Equipment Machinery Depreciation over time Disposables lines hemofilters bunchman

Hospital Cost Pharmacy Solutions Industry made Pharmacy produced Change in drug dosing due to increase clearance TPN losses Heparin, Citrate, Calcium bunchman

Hospital Cost Nursing Isolated Critical Care Programs start up time continuous care time Programs supported by both Dialysis staff and Critical Care staff start up time (done by dialysis staff) continuous care time (done by Critical Care staff) bunchman

Physicians Charges Isolated Critical Care programs Access placement Prolonged constant attendance Dialysis Charge Programs by both Dialysis and PICU Access placement (PICU charge) Prolonged constant attendance (PICU charge) Dialysis Charge (Nephrology Charge) bunchman

CPT codes for Physician Charges Access Placement 36488 (< 2 yrs of age) 36489 (> 2 yrs of age) Prolonged Constant Attendance 99356 initial 30-74 minutes 99357 each additional 30 minutes and can include the last 15 minutes of the visit for the day bunchman

CPT codes for Physician Charges Dialysis Charges Hemodialysis 90935 with single evaluation of patient 90937 with multiple evaluations of patient CRRT/Peritoneal Dialysis 90945 with single evaluation of patient 90947 with multiple evaluation of patient bunchman

How can Nephrology affect (positively) PICU admissions bunchman

More patients on CRRT means more PICU patients Pt # bunchman

Conclusion Unfortunately, billing is an issue that cannot be ignored CRRT is a modality that serves patients well PCRRT has potentially hidden avenues that will allow for capturing of charges in order to support a PCRRT program bunchman