Kidney Care and Nephrology Coordination
As the primary care provider, you play a central role in managing Chronic Kidney Disease (CKD). This work is billable. Use Chronic Care Management (CCM) codes to capture time spent coordinating with nephrologists. It is vital to use specific ICD-10 codes that reflect the stage of CKD (e.g., N18.3 for Stage 3) to demonstrate medical necessity for ongoing management and testing.
Common Urology Billing in Family Practice
Family practices can handle and bill for many routine urologic services. This includes CLIA-waived tests like a urinalysis (CPT 81002) or using a bladder scanner to check post-void residual (PVR) volume (CPT 51798). Knowing which services you can confidently perform and bill for in-house versus when to refer to a urologist is key to efficient and compliant care.
Speech and Hearing Evaluations
While full diagnostic workups are done by specialists, family providers can bill for screenings. For example, a pure tone audiometry screening uses CPT code 92551. It's important to understand the distinction: a screening identifies potential issues, while a full evaluation diagnoses them. Documenting the reason for the screening and the subsequent referral (if needed) is crucial.
The Foundational Role of Credentialing
You cannot be paid for services you are not credentialed to perform. Before you offer any specialized testing or evaluation, you must ensure that both your practice and the individual provider are properly enrolled and credentialed with each specific payer. Billing for a service without being credentialed is a fast track to claim denials and potential fraud accusations.
The Golden Rule: Credentialing comes first. Always. Verify your status with a payer before introducing a new service line.
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