How To Use HCPCS Code A4765

HCPCS code A4765 describes a dialysate concentrate in powder form that is used as an additive for peritoneal dialysis. This code is specifically used to identify the supply of dialysate concentrate per packet. It is important for medical coders to understand the meaning and usage of this code in order to accurately bill for the service.

1. What is HCPCS A4765?

HCPCS code A4765 is used to identify the supply of dialysate concentrate in powder form that is used as an additive for peritoneal dialysis. This code represents a specific product that is used in the treatment of patients with end-stage renal disease (ESRD) who undergo peritoneal dialysis. It is important to note that this code is not applicable for other types of dialysis or for patients who do not require peritoneal dialysis.

2. Official Description

The official description of HCPCS code A4765 is “Dialysate concentrate, powder, additive for peritoneal dialysis, per packet.” This description accurately reflects the purpose and use of the product represented by this code. The short description for this code is “Dialysate conc pow per pack.”

3. Procedure

1. The provider prepares the peritoneal dialysis solution by adding the appropriate amount of dialysate concentrate powder to a specific volume of sterile water.
2. The provider ensures that the dialysate concentrate powder is fully dissolved in the sterile water to create a clear and properly mixed solution.
3. The provider then administers the prepared peritoneal dialysis solution to the patient through the peritoneal catheter.
4. The dialysate solution remains in the patient’s peritoneal cavity for a specified period of time, allowing for the exchange of waste products and excess fluids.
5. After the prescribed dwell time, the provider drains the used dialysate solution from the patient’s peritoneal cavity and replaces it with fresh solution.
6. This process is repeated according to the patient’s prescribed peritoneal dialysis schedule.

4. When to use HCPCS code A4765

HCPCS code A4765 should be used when billing for the supply of dialysate concentrate powder used as an additive for peritoneal dialysis. It is important to ensure that the patient’s medical records clearly indicate the use of peritoneal dialysis and the specific product provided, as represented by this code. This code should not be used for other types of dialysis or for patients who do not require peritoneal dialysis.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A4765, healthcare providers should ensure that the following documentation is included:

• Medical records indicating the use of peritoneal dialysis for the treatment of the patient’s end-stage renal disease.
• Documentation specifying the quantity of dialysate concentrate powder provided per packet.
• Proof of medical necessity for the use of peritoneal dialysis and the specific product represented by this code.

6. Historical Information and Code Maintenance

HCPCS code A4765 was added to the Healthcare Common Procedure Coding System on January 01, 1986. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has remained unchanged since its inclusion in the coding system.

7. Medicare and Insurance Coverage

HCPCS code A4765 is covered by Medicare and other insurance providers. However, it is important to note that the pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the cost of the dialysate concentrate powder is bundled or included in the overall reimbursement for peritoneal dialysis services. Therefore, healthcare providers should not bill separately for this supply.

8. Examples

Here are five examples of when HCPCS code A4765 should be billed:

1. A patient with end-stage renal disease undergoes peritoneal dialysis and requires one packet of dialysate concentrate powder for each dialysis session.
2. A healthcare provider supplies a month’s worth of dialysate concentrate powder to a patient who performs peritoneal dialysis at home.
3. A patient receives peritoneal dialysis in a healthcare facility and requires additional dialysate concentrate powder during their stay.
4. A patient with end-stage renal disease travels and requires a supply of dialysate concentrate powder for peritoneal dialysis while away from their regular healthcare facility.
5. A healthcare provider orders a specific brand or formulation of dialysate concentrate powder for a patient with specific medical needs.