Donor Post-Kidney Transplant Complications Billing Clarified

November 14th, 2011

The Centers for Medicare & Medicaid Services (CMS) has updated the Medicare Claims Processing Manual to include new instructions for billing donor post-kidney transplant complication services.

Section 90.1.3 of the manual (effective April 1, 2012) now specifies, “Expenses incurred for complications that arise with respect to the donor are covered and separately billable only if they are directly attributable to the donation surgery.”

Covered services for such complications are billed under the recipients claim number, and each covered service must be reported with modifier Q3 Live kidney donor and related services. Institutional claims most also include an occurrence code 36 Date of inpatient hospital discharge for covered transplant patients and a patient relationship code 39 Organ donor.


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4 Responses to Donor Post-Kidney Transplant Complications Billing Clarified

  1. Ranae Hedges Says:
    November 16th, 2011 at 11:34 am

    keep this one for future reference

  2. Robert F. Hickey, Ph.D. Says:
    November 16th, 2011 at 1:16 pm

    Most transplant coordinators do not know this coverage is available. Some transplant centers are telling altruistic, non-related, living donor transplant recipients they must provide private health insurance coverage for the living donor. This is done mostly to discourage such transplants.

  3. livingdonor101 Says:
    November 23rd, 2011 at 2:48 pm

    Ph.D or not Mr. Hickey, you are incorrect with your assumption. Medicare coverage of kidney transplant recipients and living donors has been available since 1972, decades before non-related donations became possible (ALL donors are altruistic; please don’t co-opt the term).

    However, most recipients are covered by private insurance and it is the private insurance that is billed for living donor complications first. Only then would Medicare be billed. However, as stated, donors are billed under the RECIPIENT’S claim number – what if the recipient doesn’t have a claim number? ‘

    A memo in 1974 from CMS put LDs under the recipient’s benefit, depriving us of our own. The explanation given by CMS was “We didn’t plan on paying for all of this”. Well, no living donor I ever encountered planned on nerve damage, hernia, pancreatitis, chylous ascities, adrenal dysfunction, depression, anxiety, PTSD, cardiac disease, hypertension or otherwise. Yet these things have, can and do happen.

    Transplant coordinators don’t know about the Medicare benefit for living donors in general because of this 1974 directive. THIS is what has caused the problem for ALL living donors; it has nothing to do with discouraging’ non-related donations.

    For more info: http://www.livingdonor101.com

  4. Robert F. Hickey, Ph.D. Says:
    March 21st, 2012 at 7:51 am

    livingdonor101.com presents so much misinformation in the above response it does deserve a response, however, it would take too much time to bring the writer up to an adequate level of knowledge. The ignorance is astounding!

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