End-Stage Renal Disease Laboratory Tests Job Aid
Dialysis Type: Hemodialysis, CCPD, IPD, Hemofiltration
Non-AMCC Laboratory Tests
| Frequency/CPT Codes | Test Name/Abbreviation |
|---|---|
| Per treatment: 85013 or 85014 85018 Various | Hematocrit (Hct) Hemoglobin (Hgb) Clotting tests (incident to dialysis) |
| Weekly/13 Per Quarter: 85610 | Prothrombin time (PT)—when receiving anticoagulant therapy |
| Monthly: 85025 or 85027 | Complete blood count (CBC) |
AMCC Laboratory Tests
| Frequency/CPT Codes | Test Name/Abbreviation |
|---|---|
| Weekly/13 Per Quarter: 82565 84520 | Serum creatinine Blood urea nitrogen (BUN) |
| Monthly: 82310 82330 82330 82374 84075 84132 84100 84450 82435 84155 83615 82040 | Serum calcium Calcium, ionized (billed with CD or CE modifier)* Calcium, ionized (billed with CF modifier) noncomposite* Serum bicarbonate (carbon dioxide) Alkaline phosphatase Serum potassium Serum phosphorous Aspartate aminotransferase (AST)/Serum glutamic-oxaloacetic transaminase (SGOT) Serum chloride Total protein, except by refracometry Lactate dehydrogenase (LDH) Serum albumin |
Laboratory Tests Not included in the Case-Mix Composite Rate—Separately Billable Once Every 3 Months
| CPT Codes | Test Name |
|---|---|
| 82108 82728 | Serum aluminum Serum ferritin |
* Note concerning AMCC Modifiers: Effective 1/1/2014, the AMCC 50 percent rule no longer applies; thus, the AMCC modifiers are no longer applicable and no separate payment is made (CR 8261).
Note: Additional laboratory tests may be medically reasonable and necessary for a specific medical condition. Only laboratory services that are eligible for outlier payment should be included on the ESRD claim for payment.
Reminder: AY modifier is used as an attestation that the item or service is medically necessary for the patient but is not being used for the treatment of ESRD. ESRD facility should only use the AY modifier when the laboratory test is not subject to ESRD PPS or related consolidated billing requirements.
Reminder: National Government Services LCDs and CMS NCDs apply to all services billed to National Government Services Medicare.
Dialysis Type: Continuous Ambulatory Peritoneal Dialysis
Non-AMCC Laboratory Tests
| Frequency/CPT Codes | Test Name/Abbreviation |
|---|---|
| Monthly: 85018 85013 or 85014 | Hbg (hemoglobin) Hct (hematocrit) Dialysate Protein |
AMCC Laboratory Tests
| Frequency/CPT Codes | Test Name/Abbreviation |
|---|---|
| Monthly: 84520 82565 82040 84295 84132 84075 84100 82374 83735 83615 84450 84155 82310 82330 82330 | BUN Serum Creatinine Serum Albumin Sodium Serum Potassium Alkaline Phosphatase Serum Phosphorus Serum Bicarbonate Magnesium LDH AST / SGOT Total Protein Serum Calcium* Ionized calcium (billed with CD or CE modifier)* Ionized Calcium (billed with CF modifier)* |
Typical Frequency
| CPT Code | Test Name/Abbreviation |
|---|---|
| Separately Billable Every 3 Months: | |
| 85048 85041 85049 | White blood cell count (WBC) Red blood cell count (RBC) Platelet count |
| Separately Billable Every 6 Months: | |
| 81050 | 24-hour urine volume Residual renal function |
* Note concerning AMCC Modifiers: Effective 1/1/2014, the AMCC 50 percent rule no longer applies; thus, the AMCC modifiers are no longer applicable and no separate payment is made (CR 8261).
Note: Additional laboratory tests may be medically reasonable and necessary for a specific medical condition. Only laboratory services that are eligible for outlier payment should be included on the ESRD claim for payment.
Reminder: AY modifier is used as an attestation that the item or service is medically necessary for the patient but is not being used for the treatment of ESRD. ESRD facility should only use the AY modifier when the laboratory test is not subject to ESRD PPS or related consolidated billing requirements.
Reminder: National Government Services LCDs and CMS NCDs apply to all services billed to National Government Services Medicare.