Nephrology practices manage chronic kidney disease, end-stage renal disease, dialysis, electrolyte disorders, and kidney transplant follow-up. Accurate ICD-10 coding and ESRD billing are critical for Medicare reimbursement under the ESRD Prospective Payment System. Updated for FY2026 ICD-10-CM (effective Oct. 1, 2025) and CPT 2026, with FY2027 ICD-10-CM changes (effective Oct. 1, 2026) noted where added. This page covers the top codes used by nephrologists in the US.
FY 2027 ICD-10-CM (CMS, eff. 10/1/2026) · CPT 2026 (AMA) · All codes verified billable · Last verified: October 2026
Creation of arteriovenous fistula, non-autogenous graft
N/A
-RT, -LT, -59
50200
Renal biopsy, percutaneous, by trocar or needle
~$492
-26, -TC, -RT, -LT
99445
Remote physiologic monitoring device supply with data transmission, 2–15 days within a 30-day period (new CPT 2026)
~$52
None typically required
99470
Remote physiologic monitoring treatment management, first 10 minutes of clinical staff/physician time with patient/caregiver interaction per calendar month (new CPT 2026)
~$26
None typically required
*Approximate 2026 CMS national non-facility rate. Rates vary by geography, setting, and payer contract. Refer to the CMS Physician Fee Schedule for official rates.
Top Denial Reasons for Nephrology Claims
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Medical Necessity Not Documented
Claims for dialysis management or CKD monitoring are denied when physician notes lack explicit documentation of the stage of kidney disease and current GFR/lab values. Ensure every encounter note references the specific CKD stage, relevant labs, and clinical rationale for the visit frequency.
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Missing or Incorrect Modifier on ESRD Monthly Services
ESRD monthly capitation codes (90960-90962) are denied when the -GV (physician supervising but not owner of ESRD facility) or -GW (unrelated to ESRD) modifier is omitted or applied incorrectly. Verify modifier selection based on the physician’s relationship to the dialysis facility before submission.
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Diagnosis-Procedure Code Mismatch
Hemodialysis or peritoneal dialysis CPT codes submitted without a supporting ESRD/CKD diagnosis (N18.6, Z99.2) trigger automatic edits and denials. Always link dialysis procedure codes to the correct ICD-10 diagnosis and ensure the claim’s diagnosis pointer is correctly assigned.
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Prior Authorization Not Obtained for AV Fistula Creation
Surgical access creation codes such as 36818-36830 frequently require prior authorization from commercial and Medicare Advantage plans, and claims without a valid auth number are denied on first pass. Confirm authorization requirements and obtain approval before scheduling the procedure.
N18.3 is Chronic kidney disease, stage 3. CMS further delineates N18.31 (Stage 3a, GFR 45–59) and N18.32 (Stage 3b, GFR 30–44) for specificity. Always code to the most specific stage supported by the GFR value documented in the chart.
What is the correct code for ESRD?
N18.6 is End-Stage Renal Disease. It is required for all ESRD patients on dialysis. Add Z99.2 (dependence on renal dialysis) as an additional code when applicable. ESRD patients are covered under Medicare Part B regardless of age.
When should I use I12 vs I10?
When hypertension and CKD coexist, code I12.9 (hypertensive CKD, stage 1–4) or I12.0 (with stage 5 CKD or ESRD). Do not code I10 and N18.x separately — ICD-10 convention assumes a causal relationship between hypertension and CKD.
What CPT code is used for dialysis?
90935 covers hemodialysis with one physician evaluation. 90937 is used when multiple physician evaluations occur during a hemodialysis session. Peritoneal dialysis uses 90945 (single evaluation) or 90947 (multiple evaluations).
How does OmniMD support nephrology practices?
OmniMD’s Nephrology EHR includes CKD staging calculators, eGFR tracking, ESRD monthly capitation billing tools, and integrated lab result feeds from major dialysis centers.
Streamline Your Nephrology Practice with OmniMD
Purpose-built EHR, billing, and practice management for Nephrology practices.
