Dialysis Mystery Breakout

Mystery Breakout

Dialysis

Start

Greetings, Investigator!

You're headed to Headquarters to review important files related to the Dialysis Mystery. Get ready to tackle four unique missions that will challenge your skills and deepen your understanding of dialysis treatment.

Continue

Click ' Continue' to view the index file with your missions.

Mission 1: POLICY PATROL

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Locked

Locked

Click on the first file index to start the journey. The other missions are locked and will require a key to open them.Find all the keys and solve the Dialysis Mystery!

Read the question in entirety and click the correct answer below.

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14

Your provider is billing for all dialysis treatment's (CPT 90999) received between January 1st and January 31st. How many days/units can the provider bill for the month without using a modifier?

CLUE: Click the yellow link icon to access Novitas and review ESRD billing requirements. Once you reviewed the details, answer correctly to proceed.

Great Job! The billable max for dialysis treatment (CPT 90999) days/units is 14 for any calendar month with 31 days, like January. Click the green arrow to go left into the alley, where the storage room is located.

CLUE: Click the yellow link icon to access Novitas and review ESRD billing requirements. Once you reviewed the details, answer correctly to proceed.

The storage room door is to your left, but to open it you need to determine how many times the provider can bill the drug Aranesp (HCPCS J0882) during dialysis treatment for the entire month of January.

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5

Great Job! The billable max for Aranesp (HCPCS J0882) units is 5 for any calendar month 30 or 31 days, like January. Click the green arrow to enter the storage room and find the key to unlock the next mission.

You see several file drawers in front of you, but only one holds the key to your next mission. The correct file cabinet will be the billable max for 90999 and J0882 for the month of January.

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Add both maxes for the month, this will be the number of the correct file cabinet; click the correct file cabinet.

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You Found the Key!Click the Key to return to the file index and unlock the next mission.

Mission 2:DOSE DILLEMA

Completed

Locked

Locked

The search continues! You have unlocked Mission 2! Click on Mission 2 to receive instructions to the next key. Find all the keys and solve the Dialysis Mystery!

Dr. Brown administered 5,000 units of J0587 to a patient. The vial of J0587 is 9,000 units. How many billable units should be submitted, and how should wastage be reported using the 'JW' modifier?

Submit 5,000 units and 4,000 units using the 'JW' modifier.

Submit 5 units and 4 units using the 'JW' modifier.

Submit 50 units and 40 units using the 'JW' modifier.

CLUE: Click the yellow slippery floor sign to review key steps to determine units.

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B

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You've made it to Dr. Brown's office. The key to your next mission is hidden. You must answer the following question correctly to receive a clue about where the key is hidden. Click the '?' icon for the question.

Dr. Brown prescribed Q4081 at 1,400 units How many billable units should be submitted?

1,400

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Drag and move the items around in the tray. Once you find the key, click on it to continue.

Mission 3COMPLEX CLAIMS

Completed

Completed

Locked

The search continues! You have unlocked Mission 3! Click on Mission 3 to receive instructions to the next key. Find all the keys and solve the Dialysis Mystery!

A driver is waiting to take you to the payphone, but the driver has a question for you before you get in.To earn your ride, click the "?" icon to reveal the driver's question. Answer correctly, and you will be on your way!

Continue

You have Arrived!You have made it to the payphone! To get the code, you will need to answer three questions. Answer correctly to receive the code to the safety deposit box.

Click 'Continue' to answer three questions.

The claim's payment will remain the same, as BMI does not affect payments.

The claim's payment will increase due to the additional nutritional services required.

Your patient has a BMI of 16 and requires additional nutritional support during dialysis. How will this impact the claim's payment?

The claim's payment will remain the same, as this type of diagnosis does not affect payments.

Your patient has a secondary diagnosis of Nephrogenic diabetes insipidus (ICD-10 N25.1) and requires ibuprofen during dialysis. How will this impact the dialysis claim's payment?

The claim's payment will increase due to the nature of the secondary diagnosis.

Bill on a single claim for all treatments, appending a 'KX' modifier to each additional dialysis session.

A patient sufferance with sever lupus, requires additional dialysis treatments for the month of August. The provider has ordered and provided additional dialysis for a total of 18 treatments.What is the appropriate way to bill for these extra treatments?

Submit two separate claims, one for the standard 14 treatments and another for the additional treatments.

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Continue

Remember the code

Click 'Continue' to go back to the driver.

The driver is waiting for you. Click on the 'GO' button to get to take a ride, and locate the correct safety deposit box.

GO

Click the key to complete the mission and return to Headquarters!

Completed

Mission 4INPATIENT SHIFT

Completed

Completed

The search continues! You have unlocked Mission 4! Click on Mission 4 to receive instructions to the next key. Find all the keys and solve the Dialysis Mystery!

A dialysis patient, who received outpatient treatment on October 1st, was admitted as an inpatient on October 16th.What happens to the outpatient dialysis claim for October?

A) The outpatient claim will be billed for the entire month of October. Ex: 10/01/23 - 10/31/23.

B) The outpatient claim ends the day before the inpatient stay begins.

C) The outpatient will end on the day the inpatient claim begins.

A dialysis patient is set to be discharged by the end of the week. When can the provider order DME/HME for the patient?

A) On the day of discharge.

B) As early as 2 days prior to discharge.

C) Anytime during the inpatient stay.

When a dialysis patient is discharged from inpatient care, when must the start date be on the provider's claim for the DME/HME that was delivered and installed before discharge?

A) The claim start date must be the day of discharge.

B) The claim start date is the day after discharge.

C) The claim start date is the day the equipment was installed.

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Continue

Wrong answer!

Try again

POLICY PATROL

GO

MYSTERY MISSION 1

ATTENTION:Your first challenge awaits! Head south on Guideline Drive and tackle questions about billable max in dialysis. Each answer will reveal clues guiding you to the storage room.Inside, you will find a file cabinet with the key to Mission 2! Stay sharp - Click the 'GO' button below, your journey begins now!

DOSE DILEMMA

GO

MYSTERY MISSION 2

ATTENTION:Your next task is to find Dr. Brown's office in the building. Once inside, you will have to solve dosage conversions. Solve the challenge, and the key to Mission 3 will be within your reach, click the 'GO' button below.

GO

COMPLEX CLAIMS

MYSTERY MISSION 3

ATTENTION:Your next challenge is upon you! To progress, you must reach the safety deposit box that holds the key to Mission 4. But beware - this box is locked!To open it, race to the old payphone and answer the questions that await you. Your quick thinking will earn you the code needed to unlock the safety deposit box.Stay focused - your mission continues now, click the 'GO' button below.

INPATIENT SHIFT

GO

MYSTERY MISSION 4

ATTENTION:A NURSE MISTAKENLY RIPPED UP AN IMPORTANT DOCUMENT THINKING IT WAS PROTECTED HEALTH INFORMATION (PHI) AND TOSSED IT AWAY.TO COMPLETE THE FINAL MISSION, YOU WILL NEED TO PIECE THE PAPER BACK TOGETHER AND ANSWER A FEW CRITICAL QUESTIONS ABOUT NAVIGATING DIALYSIS TREATMENT BETWEEN OUTPATIENT AND INPATIENT SETTINGS.

Identify which comorbidity qualifies for additional payments and how they impact claim reimbursements.

Comorbidity Clue

GO

K57.31

G93.2

L89.02

B26.1

H01.11

Incorrect!

Incorrect!

Incorrect!

Incorrect!

Correct!

Correct, K57.31 qualifies as an Acute Comorbidity and qualifies for additional payments. Click the "GO" button below to get to the payphone.

CLUE: Click the yellow link icon to access CMS and review Comorbidity Categories. Once you reviewed the details, answer correctly to proceed.

Use the below steps to determine the correct units for a service. Click on the "X' button to select an answer.

Billable Units