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Last week's Compliance Briefing on automated lab tests for ESRD patients prompted several requests for an explanation of what other tests are included in the ESRD composite rate. One of our readers also noted that the new coding rules apply only to Medicare Fiscal Intermediaries at the present time, not Medicare Carriers. CMS should be publishing almost identical instructions to Carriers in the near future. Today's briefing covers the other composite tests and their allowed frequency for various types of dialysis. As always, please feel free to email questions, concerns, and/or suggestions.
Charles B. Root, Ph.D.
Tests included in the composite rate
The tests listed below are included in the composite rate at the indicated frequency. Tests in excess of this frequency are paid separately if they are medically necessary. Medical documentation is required to substantiate the frequency, a diagnosis of renal disease alone is not sufficient. The nature of the illness or injury (diagnosis, complaint, or symptom) requiring the performance of the additional test(....
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