1. Timothy E. Bunchman Professor Pediatrics
Billing In PCRRT
Timothy E. Bunchman
Professor Pediatrics

2. Paying attention to detail
bunchman

3. Costs/Charges associated with PCRRT
Hospital
Equipment
Pharmacy
Nursing
PICU
Dialysis
Physician
Critical Care Nephrology
? Surgery
bunchman

4. Hospital Cost Equipment
Machinery
Depreciation over time
Disposables
lines
hemofilters
bunchman

5. Hospital Cost Pharmacy
Solutions
Industry made
Pharmacy produced
Change in drug dosing due to increase clearance
TPN losses
Heparin, Citrate, Calcium
bunchman

6. Hospital Cost Nursing Isolated Critical Care Programs
start up time
continuous care time
Programs supported by both Dialysis staff and Critical Care staff
start up time (done by dialysis staff)
continuous care time (done by Critical Care staff)
bunchman

7. Physicians Charges Isolated Critical Care programs
Access placement
Prolonged constant attendance
Dialysis Charge
Programs by both Dialysis and PICU
Access placement (PICU charge)
Prolonged constant attendance (PICU charge)
Dialysis Charge (Nephrology Charge)
bunchman

8. CPT codes for Physician Charges
Access Placement
36488 (< 2 yrs of age)
36489 (> 2 yrs of age)
Prolonged Constant Attendance
99356 initial minutes
99357 each additional 30 minutes and can include the last 15 minutes of the visit for the day
bunchman

9. CPT codes for Physician Charges
Dialysis Charges
Hemodialysis
90935 with single evaluation of patient
90937 with multiple evaluations of patient
CRRT/Peritoneal Dialysis
90945 with single evaluation of patient
90947 with multiple evaluation of patient
bunchman

10. How can Nephrology affect (positively) PICU admissions
bunchman

11. More patients on CRRT means more PICU patients
Pt #
bunchman

12. Conclusion Unfortunately, billing is an issue that cannot be ignored
CRRT is a modality that serves patients well
PCRRT has potentially hidden avenues that will allow for capturing of charges in order to support a PCRRT program
bunchman