84295: Serum sodium

First Coast Service Options Inc. (FCSO) has been made aware of an issue regarding providers receiving denials when billing CPT code 84295 (Sodium; serum, plasma or whole blood) and ICD-9-CM code 585.6 (End-stage renal disease) for hemodialysis patients when modifiers CB and CF and several other modifiers identified for the automated multichannel chemistry tests (AMCC) were appended that noted the service rendered were outside the composite rate. CMS Pub 100-02, Chapter 11, Section 30.2.2 lists CPT code 84295 as excluded from the composite rate for hemodialysis, intermittent peritoneal dialysis (IPD), continuous cycling peritoneal dialysis (CCPD) and hemofiltration patients. Modifier CB is defined as services ordered by a renal dialysis facility (RDF) physician as part of the ESRD beneficiary’s dialysis benefit, is not part of the composite rate, and is separately reimbursable. FCSO has researched and corrected the issue. Providers who are billing per the language in Pub 100-02, Chapter 11, Section 30.2.2 for CPT code 84295 should append at least the CB modifier to the line for CPT code 84295 and ICD-9-CM code 585.6. Providers may append other modifiers as appropriate for AMCC services. This correction is effective for claims processed on or after January 25, 2010, for services rendered on or after October 1, 2006.

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