Female medical professional reviewing billing analytics and nephrology data on a computer screen. Text reads “Best Practices for Nephrology Medical Coding and Billing – Improve accuracy, reduce denials, and optimize your revenue cycle with expert tips from SysMD

Best Practices for Nephrology Medical Coding and Billing

Table of Contents

Billing practices play an important role in over financial stability of a hospital. When healthcare providers do not focus on these practices, they face many issues. Nephrology medical billing and coding is complex, so it needs expert tips and strategies. Kidney-related clinics that implement best billing and coding strategies in their routine receive payments timely.

In this article, we will elaborate on the importance of nephrology billing services and nephrology billing best practices. We will discuss how correct codes and tips can smooth billing processes. Moreover, we will suggest a reliable billing platform, SysMD, for efficient billing practices.

Why Nephrology Billing Best Practices are Important?

Close-up of a doctor writing on a clipboard with rising bar and line charts overlayed, symbolizing financial growth. Text reads “Why Billing Best Practices Matter in Nephrology – Effective billing ensures compliance, accuracy, and faster reimbursements.

The best billing tips are important to manage a nephrology billing system. These tips can prevent billers from making mistakes in bills and claims. Moreover, effective billing practices make billing and coding easy. They also smooth routine billing tasks and make these tasks compliant according to payer guidelines. Understanding the nephrology medical billing basics helps providers apply these best practices effectively and reduce costly errors.

Nephrology billing best practices can:

  • Manage revenue cycle management (RCM) properly to enhance revenues.
  • Make your practice compliant
  • Enhance patient experience
  • Save time and the manual efforts of staff
  • Make your billing advanced and error-free

All hospitals should know and adapt the functional billing strategies to make their practice financially stable.

What Are Best Practices for Nephrology Billing?

You can streamline your nephrology billing tasks with the help of best practices. Let us discuss some common practices that can help you in billing and coding:

Build a standardized nephrology billing workflow

Infographic titled “Build a Standardized Workflow for Smooth Nephrology Billing.” It lists four steps: Intake & Benefit Verification, Charge Capture, Coding & Review, and Claim Submission & Follow-up. The subtitle reads “Streamline your process from verification to claim submission.

A smooth nephrology billing workflow can minimize many billing complexities and errors. This workflow includes:

Intake & benefit verification

Firstly, confirm patient insurance, coverage for dialysis or nephrology services, and prior authorization requirements.

  • Note down all the services provided to the patients in the documents.
  • You can use a superbill or an integrated module for nephrology services.
  • Then, assign an accurate CPT/ICD/HCPCS code according to the services.
  • Also, add a necessary modifier to justify the services (if needed).
  • You can use a logic engine to spot missing modifiers or suspicious combinations.
  • Submit clean claims electronically to the insurance or payer companies.
  • Review all claims for patient information, codes, and guidelines. If you find any errors in the claim, correct them and resend it to the insurers.

Train your Billing Staff

Illustration of three people participating in a billing training session. A large screen displays billing codes, charts, and training modules. Text reads “Empower Your Billing Staff with Regular Training – Stay updated with CMS and Medicare billing guidelines to prevent costly errors.

Most healthcare organizations ignore this billing practice. That is why they seem to stay on old practices and revenue losses. Training your billing staff can give you a lot of benefits. You can:

  • Educate your staff on updated billing guidelines
  • Aware your coders for updated CPT and ICD-10 codes
  • Make your practice compliant
  • Gain the chances of more business growth
  • Establish a culture of “ask first”, if someone is uncertain, rather than guessing a code

Keeping your team current means fewer surprises, fewer denials, and more consistent revenue capture. So, you should organize training sessions whenever CMS updates its nephrology billing guidelines.

Conduct regular internal audits

Close-up of financial documents labeled “Billing” with a magnifying glass, checklist, and calendar on a desk. Text reads “Conduct Regular Internal Billing Audits – Detect coding errors, prevent denials, and ensure compliance with proactive reviews.

Nephrology billing best practices include conducting audits regularly. Proactive audits are an indication of top practices. The steps of conducting audits in routine are as follows:

  • Check a set of nephrology claims (both paid and denied) monthly or quarterly.
  • Compare billed CPT codes vs. documentation; check for upcoding or missing modifiers.
  • Review denials to identify patterns (e.g., frequent “medical necessity” denials for dialysis codes).
  • Provide feedback, correct processes, and retrain staff as needed.

These steps can help you improve billing and coding tasks. You can reduce errors and claim denials by conducting internal audits. Moreover, you will get to know the challenges and mistakes and will work on them.

Follow payer-specific requirements

All payers and insurance companies provide their policies. Usually, these policies are specific to every procedure and claim. Hospitals must follow these policies and requirements. Those who do not follow them in their practice face claim denials. Insurers reject the claims temporarily or permanently when they violate these guidelines. Thus, follow payer-specific requirements in your billing tasks.

For more nephrology billing best practices, see our companion post Billing Challenges in Nephrology. It will help you to know the reasons for billing issues and how these practices can solve challenges.

How Can Nephrology Practices Avoid Coding Mistakes?

Infographic titled “Top Coding Tips to Avoid Errors in Nephrology Billing.” It lists four key points: Accurate Documentation, Correct Use of Modifiers, Technology Integration, and Proper CPT Code Selection. The image shows a computer screen with medical coding entries like CPT codes 90935 and 90937.

Coding is an important part of nephrology billing. It directly impacts reimbursement and payments for the healthcare organization. Most errors occur during coding. In this step, coders assign a specific number (code) according to the services and diagnoses in the nephrology field. These codes are already recommended by CMS to the hospitals.

All hospitals must follow these codes in their billing routine. When they do not incorporate coding guidelines or correct codes, they face billing and compliance issues.

Some nephrology coding tips that can avoid coding mistakes are as follows:

Accurate Documentation

Accurate documentation in nephrology billing is important. When staff enter correct services or diagnoses on the documents, it leads to the formation of correct bills. There are some tips to improve documentation practices:

  • Note the start and end times of dialysis sessions, prescription changes, complications, and physician interventions.
  • Make clear notes when the physician evaluates the patient during dialysis (to justify 90937).
  • Record justification for additional procedures (e.g., access surveillance, catheter adjustments).
  • Use a clear chronological sequence of events so that any payer auditor can trace the logic of services rendered.

Use Technology

Using advanced technology can make billing effortless. Nephrology billing best practices also encourage the use of innovative technology in billing tasks. Modern billing and EHR (Electronic Health Record) systems can help in:

  • Ruling engines to detect incompatible CPT/modifier combinations.
  • Alerting when units exceed typical thresholds.
  • Indicating flags for missing documentation or missing links to diagnoses.
  • Automating crosswalks between diagnosis and procedure codes.

What CPT Codes Are Most Common in Nephrology?

In nephrology, CPT codes are specific for every disease and service. Understanding correct CPT codes in nephrology is important:

Some major CPT codes are as follows:

  • CPT 90935: Hemodialysis procedure with a single physician evaluation during the session.
  • CPT 90937: Hemodialysis with repeated evaluations or prescription adjustments in the same session.
  • CPT 90945 / 90947: For peritoneal dialysis and other non-hemodialysis therapies with the inclusion of physician evaluation.
  • CPT 90940: Hemodialysis access flow study to evaluate vascular access patency.
  • CPT 90999: Unlisted dialysis procedure used when no other code fits.

These codes form the foundation of nephrology billing in dialysis and ESRD care.

Choose SysMD for the best practices in Billing

Professional working on a computer displaying billing dashboards and analytics. Text reads “Choose SysMD for Smart Nephrology Billing and Coding Solutions – Certified coders. Proven compliance. End-to-end nephrology billing expertise

SysMD is a specialized billing team that offers end-to-end medical coding, billing, and revenue cycle solutions powered by domain expertise in niche specialties such as nephrology. Their team of certified coders, compliance frameworks, and intelligent automation ensures that your practice maximizes nephrology billing best practices.

With SysMD, nephrologists can focus on patient care, not claims management — and rest assured that every CPT 90935, 90937, ESRD billing code, or renal dialysis procedure is captured correctly and efficiently.

Conclusion

Nephrology billing is complex due to chronic care management, frequent dialysis services, and evolving payer rules. But by adopting a disciplined, proactive approach grounded in nephrology billing best practices, you can reduce denials, safeguard revenue, and deliver quality care to patients.

Choose SysMD for the following best practices and for reducing errors in nephrology billing.

FAQs

What is the difference between CPT 90935 and 90937?

CPT 90935 is used when a single provider evaluation occurs during a hemodialysis session; 90937 is used when repeated evaluations or adjustments to the dialysis prescription are done in the same session.

Many high-performing practices audit monthly or quarterly, sampling both accepted and denied claims to detect trends and correct errors proactively.

These monthly or interval codes cover physician management of ESRD patients, whether in outpatient, home dialysis, or partial-month scenarios — they complement per-session dialysis coding.

Yes — modifiers such as -25 (separate E/M), -59 (distinct procedure separation), or telehealth modifiers may be applicable, depending on payer rules. The use must be well documented.

Automation (via EHR integration, rule logic, alerts, and RPA) can flag coding or documentation errors before claim submission, accelerate cycle time, and reduce manual workload.