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Medical Coding News Archives

Administration of End-Stage Renal Disease Drugs

May 16, 2013:

Nannette Orme, CPC, CCS-P, CPMA, CEMC, Clinical/Technical Editor

Transmittal 2688 was released April 26, 2013, to address issues related to the administration of drugs and biologicals for patients with end-stage renal disease (ESRD).

Drugs and biologicals are often administered during the administration of dialysis for patients with ESRD. Beginning July 1, 2013, Medicare will require the use of modifier JE Administered via dialysate, when appropriate.

Modifier JE is separate from modifier AY Item or service furnished to an ESRD patient that is not for the treatment of ESRD. The Centers for Medicare and Medicaid Services believes that there has been confusion over whether a drug or biological is related to the treatment of ESRD. The addition of modifier JE will allow the agency to monitor those drugs administered via the dialysate and refine the ESRD prospective payment system (PPS). CMS notes that all drugs and biologicals administered for the treatment of ESRD are considered part of the ESRD PPS regardless of the route of administration.

Modifier AY should be used to identify the non ESRD drug or biological. CMS includes a list of consolidated supplies, drugs, and biologicals included in the ESRD PPS rate. The transmittal specifically states that if a separately billable drug or biological is administered via the dialysate, modifier JE must be appended.

CMS will continue to recognize modifiers JA Administered intravenously, and JB Administered subcutaneously, as appropriate routes of administration for ESRD-related drugs and biologicals.

Note that an ESRD facility reports ESRD and non-ESRD-related drugs and biologicals when facility staff administer them at the facility. Although the drug or biological may be reported separately, the time to administer the medication is part of the composite rate.

Other ESRD-related modifiers include ED, EE, and GS. The reporting of modifiers with ESRD services is required for monitoring of treatment, patient condition, and reimbursement.


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