Nephrology billing
Dialysis MCP billing, ESRD-specific rules, and AVF/AVG procedure coding — a niche where general billers consistently lose money.
Nephrology billing is dense — getting MCP categorization wrong by one visit-frequency tier costs hundreds per patient per month. Compounded across a panel, the difference is enormous.
Where revenue leaks
The nephrology traps we see most
Patterns we run into across Neph practices in Texas. None are obvious from a 30,000-foot view of the practice — they show up only when someone's actually looking at every claim.
MCP billing per-month errors
Monthly Capitated Payment (90951–90970) for ESRD patients on dialysis is billed monthly with specific visit-frequency requirements (1 vs. 2–3 vs. 4+ visits). Wrong code = wrong payment. Audited closely.
Home dialysis training/oversight missed
Home hemodialysis and PD have separate billing codes (90989/90993 training, 90963–90966 monthly home). Practices often default to in-center MCP codes and underbill home patients.
AVF/AVG procedure under-coding
AV fistula creation, fistulagram, angioplasty, thrombectomy each have specific codes. Catheter placement codes (36558, 36561) and tunneled vs. non-tunneled distinction matters.
Hospital consultation under-billed
Inpatient nephrology consults (99221–99233 after 99251–99255 retirement) on AKI patients require careful E/M leveling — frequently under-coded as 99232 when MDM justifies 99233.
Coding focus
Where our coders specialize
- MCP codes (90951–90961 face-to-face per month, 90963–90966 home)
- Initial training (90989, 90993)
- Vascular access procedures (36558, 36561, 36818, 36819, 36821)
- Fistulagram/intervention (36901–36909)
- Inpatient consultation E/M (99221–99233)
- Hospital observation, critical care
Texas payer notes
Local rules we navigate every day
- Medicare ESRD requires specific Method I/II election forms and is audited for compliance
- Texas Medicaid coverage for ESRD coordinates with Medicare — dual-eligible workflow matters
- Commercial payers handle vascular access differently (some bundle more aggressively)
Neph KPIs we track
Specialty-specific benchmarks
We tailor reporting per specialty — these are the metrics that matter most for nephrology.
100%
MCP visit-frequency accuracy
100%
Home dialysis billing capture
<3%
Vascular access denial rate
What's your nephrology practice leaking?
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Other specialties we serve