Fee Navigator®

    03.04J Complex Care Plan expanded

    Chronic renal failure

    The Complex Care Plan has been expanded to include chronic kidney disease defined as stage 2 or higher.

    A patient is considered to be at stage 2 chronic kidney disease when there is a mild reduction in GFR (60–89 mL/min/1.73 m2) with a presence of kidney damage. A kidney is considered damaged when there are confirmed pathological abnormalities or markers of damage, including abnormalities in blood or urine test or imaging studies. The presence of Stage 3, 4 or 5 CKD continues to meet criteria for the Complex Care Plan and is identified by GFR<60 mL/min/1.73 m2)

    Download the updated template (to include chronic renal failure)
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    The rules for claiming the 03.04J remain the same, the patient must have two or more qualifying conditions, one from column A and one from column B, or two from column A.

    The diagnostic codes for chronic renal failure are:

    • 585 Chronic renal failure

    For more advice from AMA staff on any billing issues, including explanations of recent billing changes, please email AMA billing staff.