36357

FISS Narrative:
The dialysis services on this end-stage renal disease (ESRD) claim exceeded the limit routinely allowed for these dates of service and additional justification was not found.

Explanation and Suggestion:

  • The limit for dialysis visits is three per seven calendar days
  • This reason code indicates that the number of dialysis visits billed on this claim exceeds that limit for the dates of service billed, and there is no additional justification (usually a diagnosis code(s)) on the claim
  • ESRD guidelines require specific documentation when the dialysis service limits are exceeded and this documentation must be provided to pay these services
  • Please correct and resubmit/rekey
  • Hard copy submitters resubmit RTP report with corrections

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