Home Dialysis Training and Retraining
Self-dialysis and home dialysis training are provided by Medicare certified ESRD facilities that educate end stage renal disease (ESRD) patients and their caregivers to perform self-dialysis in the ESRD facility or home dialysis including continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) with little or no professional assistance.
Self-dialysis training can occur in the patient’s home or the in-facility when it is provided by the qualified staff of the ESRD facility.
Home dialysis training services and supplies may include, but are not limited to:
- Personnel services
- Dialysis supplies
- Parenteral items used in dialysis
- Written training manuals and materials, and
- Renal dialysis laboratory tests
Frequency
| Modality | Training |
|---|---|
| Hemodialysis | 5 hour sessions, 3 times a week; no more than 25 |
| Intermittent Peritoneal Dialysis (IPD) | 10-12 hour sessions; up to 4 weeks |
| CAPD | 1 session per day, 5 - 6 sessions per week for 2 weeks; no more than 15 |
| CCPD | 1 session per day, 5 sessions per week for 2 weeks; no more than 15 |
Note: Effective April 1, 2017, there will be a limit to the number of training treatments; 25-hemodialysis, 15-CAPD/CCPD.
Supplemental Dialysis During CAPD Training
It may be necessary to supplement the patient’s dialysis during CAPD training with intermittent peritoneal dialysis because the patient has not yet mastered the CAPD technique.
Generally, no more than three supplemental intermittent peritoneal dialysis sessions are required during the course of CAPD training, and these may be covered routinely.
If more than three sessions are billed during training, the claims must be documented for medical necessity.
Under certain circumstances, the form of supplemental dialysis may be hemodialysis.
Training Condition Code
Currently, when billing for training and retraining, you report condition code 73.
Effective July 1, 2017, you must report condition code 87 (ESRD self-care retraining) for retraining treatments.
Continue to report condition code 73 for training.
Retraining
Payment is made for retraining self-dialysis education after a patient or caregiver has completed the initial program, if the patient continues to be an appropriate candidate for home dialysis.
Most patients receive additional training on the use of new equipment, a change in their caregiver, or a change in modality.
The ESRD facility may not bill for retraining services when they install home dialysis equipment or furnish monitoring services. For example, an ESRD facility nurse may not bill for retraining sessions to update treatment records, order new supplies, or add additional medicine for the treatment of infection.
Payment
Under ESRD Prospective Payment System, dialysis training sessions receive a training add-on payment adjusted by the geographic area wage index that accounts for nursing time for training treatments.
The add-on payment applies to both peritoneal dialysis and hemodialysis training treatments.
Updates to the training add-on payment are published through rulemaking.
References