Reporting the Kt/V for ALL ESRD Claims

Kt/V (K-dialyzer clearance of urea; t-dialysis time; V-patient’s total body water)

All ESRD claims with dates of service on or after July 1, 2010 must indicate the applicable Kt/V reading for the dialysis patient. The reading result and the date of the reading must be reported on the claim using the following claim codes:

Value code D5: Result of last Kt/V reading
For in-center hemodialysis patients, this is the last reading taken during the billing period.

For peritoneal dialysis patients (and home hemodialysis patients), this may be before the current billing period but should be within 4 months of the claim date of service.

Occurrence code 51: Date of last Kt/V reading

For in-center hemodialysis patients, this is the date of the last reading taken during the billing period.

For peritoneal dialysis patients (and home hemodialysis patients), this date may be before the current billing period but should be within 4 months of the claim date of service.

Kt/V Test Not Performed

In the event that the provider has not performed the Kt/V test for the patient, the provider must attest that no test was performed by reporting the value code D5 with a 9.99 value.

The occurrence code date should not be reported on the claim in the case of no Kt/V reading being reported.

Failure to Report D5 Value

For dates of service on or after July 1, 2010, failure to report the D5 value code on the 72x bill type will result in the claim being returned to the provider.

In addition, Medicare will return 72x bill types with dates of service on or after July 1, 2010, to the provider if the claim does not contain occurrence code 51, except where there is a D5 value code with 9.99.

Line Level Codes

The following line level codes are to be reported on dialysis revenue code lines:

V8 Dialysis related infection present during the billing month

V9 No dialysis related infection present during the billing month