I’m auditing a provider whom sees/manages dialysis for a patient at a free standing dialysis clinic. The physician is billing 90970 daily because there was no comprehensive visit done for the month and it’s less than a full month however, there are charges for days that the patient isn’t in the clinic? For example, I was looking at one date of service where he billed a 90970 and Medicare paid however when I requested to review the note for this dos I was told there was no note because the patient wasn’t seen in the clinic that day. When I reviewed the billing and compared to the notes I had, there were several dates billed with this code in April, but I only had 3 notes. What am I missing here? My interpretation of 90970 is that the provider would need to see the patient face to face and document the days he/she’s seen the patient in order to bill??

So my bottom line question is, can 90970 be billed daily by the provider whom is managing the dialysis plan for the patient for less than a full month, regardless of seeing the patient face to face?

I haven’t audited nephrology before and I’m not familiar with dialysis so any information or insight would be greatly appreciated!

Thank you,
Melanie S