AI Scribe for Nephrologists
CKD clinic, in-center hemodialysis monthly visits, transplant follow-ups, and electrolyte consults — documented in seconds. PatientNotes captures eGFR / UACR slope, Kt/V and access exam, CKD-MBD parameters, and tacrolimus troughs, then maps them to the right CPT and ICD-10 codes.
Documentation for Every Nephrology Visit
From a 15-minute brief weekly dialysis visit to a complex new-patient transplant evaluation, PatientNotes uses the right structure for the encounter.
CKD Management
CKD staging by eGFR (G1-G5) and UACR (A1-A3), slope analysis, BP target, RAAS blockade, SGLT2 inhibitor candidacy, and dialysis preparation when eGFR <20.
In-Center Hemodialysis Visit
Comprehensive MCP-eligible note: dry weight, IDWG, BP pre/post, Kt/V, URR, access exam, ESA dose, IV iron, mineral and bone, and ICD-10 specificity.
Transplant Follow-up
1-month / 3-month / annual transplant visits: tacrolimus trough, MMF dose, valganciclovir/Bactrim prophylaxis, BK / CMV PCR, BP, and proteinuria.
Glomerular Disease
IgA nephropathy, FSGS, membranous (PLA2R), lupus nephritis, ANCA vasculitis — biopsy correlation, immunosuppression dosing, and proteinuria response.
Electrolyte Disorders
Hyponatremia (FENa, urine osm), hyperkalemia (RAAS hold vs continue, patiromer/SZC), acid-base, and refractory hypertension consult notes.
AKI Evaluation
Pre-renal vs intrinsic vs post-renal AKI, urine sediment, FENa/FEUrea, contrast nephropathy risk, and need for renal replacement therapy.
Nephrology-Specific Features
Built around the language a working nephrologist actually uses — not generic medical English.
CKD Staging & Slope
Captures eGFR (CKD-EPI 2021 race-free equation) and UACR to stage CKD as G1-G5 / A1-A3, then trends the slope visit-over-visit so a worsening trajectory lands in the assessment automatically.
CKD-MBD Parameters
Pulls calcium, phosphorus, intact PTH, vitamin D 25-OH, and alkaline phosphatase into a structured mineral-and-bone block, with KDIGO target ranges flagged so you can adjust phosphate binders, calcimimetics, and active vitamin D.
Dialysis Adequacy & Access
Documents Kt/V (single-pool and equilibrated), URR, treatment time, blood flow rate, and access exam (AVF thrill, AVG bruit, catheter site, recirculation testing) for the comprehensive monthly note.
Transplant Immunosuppression
Tracks tacrolimus / cyclosporine trough levels, MMF / azathioprine dose, prednisone taper, BK PCR, CMV PCR, and DSA monitoring with the visit-by-visit transplant note format.
Hyperkalemia / RAAS Decisions
Documents the trade-off when K+ rises on ACEi/ARB or MRA: hold, dose-reduce, or add patiromer / sodium zirconium cyclosilicate. The reasoning lands in the assessment so the next visit can re-evaluate.
CPT 99214 / 90960-90962
Suggests the right E&M level for clinic and the correct ESRD MCP code based on documented visit count for the month: 90960 (4 visits w/ full exam), 90961 (2-3), 90962 (1), plus 90945-90947 for non-ESRD dialysis.
A real day on rounds and in clinic, before and after
A typical nephrologist sees a CKD clinic of 18-25 patients on office days and rounds on 50-80 ESRD patients across one to three dialysis units on rounding days. Every patient is on six to ten cardiac and metabolic medications, half are diabetic, a quarter have a fistula needing surveillance, and the comprehensive monthly visit (CPT 90960) requires a documented full exam to bill at the high tier. The work that bleeds into the evening is rarely the medicine. It is the dialysis MCP notes for Acumen or Epic, the consult letters back to cardiology and primary care, and the prior-auth notes for SGLT2 inhibitors and GLP-1 agonists in CKD G3-G4.
With PatientNotes running in the background at the chair (or in clinic), the patient sees the same visit. You inspect the access, listen for the bruit, talk through the IDWG and the phos trend, decide whether to push the cinacalcet up. The conversation is the documentation. By the time you walk to the next chair, the comprehensive note — pre-HD vitals, access exam, dialysis Rx, Kt/V, CKD-MBD block, ESA and iron, and the suggested 90960 attestation — is drafted and waiting for your signature.
The model is tuned for nephrology. It knows that "Kt/V 1.52, URR 73%" is adequate, that "phos 5.6 on sevelamer 800 TID" means dose up before adding a second binder, and that "tacrolimus trough 6.8" in a 9-month transplant is appropriate. Notes are typically ready 30-90 seconds after the encounter, fast enough to review before the next chair.
Sample AI-Generated Hemodialysis Monthly Note
An actual comprehensive (90960) in-center HD monthly visit the model would produce. Real Kt/V, real access exam, real CKD-MBD reasoning.
IN-CENTER HEMODIALYSIS — COMPREHENSIVE MONTHLY VISIT (MCP)
Date: 04/22/2026 | CPT: 90960 (ESRD-related services, full exam, 4 visits this month)
Visits this calendar month: 4 (4/2, 4/9, 4/16, 4/22) — comprehensive exam today.
SUBJECTIVE:
68-year-old female with ESRD secondary to diabetic nephropathy, on in-center HD
3x/week (Mon/Wed/Fri) via right upper-arm AVF since 2023. Reports overall stable.
No new shortness of breath, no chest pain. Two weeks of mild pruritus, worse at
night. Denies muscle cramps on dialysis. Sleeps with 2 pillows (baseline). No
recent hospitalizations since last MCP visit. Adherent to phosphate binder. Fluid
restriction "mostly" followed; admits to a soda on the off-day.
PMH: ESRD on HD (since 2023, AVF), T2DM (since 2002), HTN, HFpEF, dyslipidemia,
prior CVA 2019 (no residual deficit), secondary hyperparathyroidism.
MEDICATIONS (reconciled):
- Sevelamer carbonate 800 mg TID with meals (phosphate binder)
- Calcitriol 0.25 mcg three times weekly (post-HD)
- Cinacalcet 30 mg daily (calcimimetic)
- Epoetin alfa 4,000 U IV three times weekly with HD (ESA)
- IV iron sucrose 100 mg weekly x 8 weeks (current protocol)
- Insulin glargine 18 U at bedtime + insulin aspart sliding scale
- Metoprolol succinate 50 mg daily; amlodipine 5 mg daily
- Atorvastatin 40 mg nightly
- Aspirin 81 mg daily
OBJECTIVE:
Pre-HD weight 72.4 kg (EDW 70.5 kg, IDWG 1.9 kg over 2 days — appropriate).
Pre-HD BP 152/78, HR 72; Post-HD BP 128/68, HR 76.
Temp 36.8C, SpO2 98% RA.
General: Comfortable, no acute distress, no asterixis.
Neck: JVP at the angle of jaw at 30 deg (mild volume excess pre-HD). No bruits.
Lungs: Clear bilaterally pre-HD. No crackles after first hour.
Cardiac: Regular rate, S1/S2 normal, soft 2/6 systolic murmur at apex (chronic).
Abdomen: Soft, non-tender, no organomegaly.
Extremities: Trace bilateral pretibial edema (down from 1+). Skin dry, mild
excoriations on forearms (pruritus exam).
Access exam (R upper-arm AVF):
- Inspection: well-developed, no aneurysm, no skin changes at cannulation sites
- Palpation: continuous thrill throughout, no pulsatility
- Auscultation: continuous low-pitched bruit
- Cannulation: clean two-needle, rope-ladder rotation
- Access flow (last KDOQI surveillance): 1,180 mL/min, no recirculation
DIALYSIS PARAMETERS (today's run):
Treatment time: 4 hours | UF goal: 2.2 L | UF achieved: 2.2 L
Blood flow rate: 400 mL/min | Dialysate flow: 600 mL/min
Dialyzer: high-flux | Dialysate K 2.0 / Ca 2.5 / HCO3 35
Kt/V (eKt/V, today's run): 1.52 (last month: 1.48 — adequate, target >=1.4)
URR: 73% (target >=65%)
No intradialytic events. Tolerated well.
LABS (most recent monthly panel):
Hgb 10.8 (target 10-11) | TSAT 28% | Ferritin 412
Ca 9.0 | Phos 5.6 (elevated) | iPTH 412 (target 2-9x ULN, ~130-590)
K (pre-HD) 4.8 | HCO3 23 | Albumin 3.8
A1c 7.2% | LDL 78
ASSESSMENT:
1. ESRD on HD x 3 years via R upper-arm AVF — adequately dialyzed (Kt/V 1.52,
URR 73%). Access flow 1,180 mL/min, no recirculation, no signs of stenosis.
2. Volume status — appropriate. EDW 70.5 kg confirmed; IDWG within target.
Mild residual edema and elevated JVP pre-HD; clears by end of run.
3. Renal anemia — at target on epoetin 4,000 U TIW + IV iron protocol.
TSAT 28%, ferritin 412 — adequate. Hgb 10.8 within KDIGO target.
4. CKD-MBD — phos 5.6 above target despite sevelamer 800 TID. iPTH 412 within
range on cinacalcet 30 mg. Ca 9.0 acceptable.
5. Pruritus — likely uremic / CKD-MBD related. Consider adding difelikefalin
if persists at next visit.
6. T2DM — A1c 7.2%, on basal-bolus insulin. No hypoglycemia events.
7. HTN — pre-HD BP 152/78, post-HD 128/68. Acceptable peri-HD profile.
8. Dyslipidemia — atorvastatin 40 mg, LDL 78. At target for ESRD.
PLAN:
1. HD Rx: continue 4 hr TIW, BFR 400, dialysate K 2.0 / Ca 2.5 / HCO3 35.
No change to UF profile. EDW 70.5 kg.
2. Increase sevelamer carbonate to 1,600 mg TID with meals to address phos 5.6.
Recheck phos with monthly panel.
3. Continue cinacalcet 30 mg daily; iPTH within target.
4. Continue epoetin 4,000 U TIW; continue IV iron weekly x 4 more doses then
re-evaluate iron indices.
5. Pruritus: try emollient + low-dose gabapentin 100 mg post-HD prn; if no
improvement at next monthly visit, start difelikefalin 0.5 mcg/kg post-HD.
6. Review access surveillance log — flow stable at 1,180 mL/min, repeat next
month per KDOQI.
7. Reinforce fluid and Na restriction; counseled on soda intake.
8. Annual influenza, pneumococcal, and shingles status reviewed — up to date.
Hep B titers >10 mIU/mL; no booster needed this cycle.
9. Next comprehensive MCP visit 5/20/2026. Brief 90961-eligible visits weekly.
Suggested ICD-10: N18.6 (ESRD), Z99.2 (dependence on renal dialysis),
E11.22 (T2DM with diabetic CKD), I12.0 (HTN with CKD),
D63.1 (anemia in CKD), N25.81 (CKD-MBD).
Suggested CPT: 90960 (ESRD MCP, age 20+, 4 visits/month with full exam).Intelligent ICD-10 Suggestions
The codes most nephrology practices bill on a daily basis — surfaced from the documentation, not guessed.
N18.30Chronic kidney disease, stage 3 unspecifiedN18.4Chronic kidney disease, stage 4 (severe)N18.5Chronic kidney disease, stage 5N18.6End stage renal disease (on chronic dialysis)E10.22Type 1 diabetes mellitus with diabetic CKDE11.22Type 2 diabetes mellitus with diabetic CKDI12.9Hypertensive CKD with stage 1-4 or unspecified CKDZ94.0Kidney transplant statusThe AI suggests relevant codes based on what you actually documented. You review and confirm — there is no auto-billing.
Nephrologists using PatientNotes today
Three composite stories drawn from real onboarding interviews. Names changed, details preserved.
Dr. Hannah Goldberg
Solo nephrologist, Tucson AZ — clinic 2 days, dialysis rounds 3 days
Hannah sees her own CKD clinic two days a week and rounds on a 55-patient ESRD panel across two dialysis units the other three days. She used to dictate the comprehensive monthly note (90960) at the unit between chairs, then re-edit at home. With PatientNotes she records the bedside exam and conversation, and the structured MCP note — Kt/V, access exam, ESA dose, mineral and bone — is ready by the time she pulls into the next chair. The $50/month was inside her own discretionary budget.
Dr. Wen Liu
Mid-size group, 5 nephrologists + 2 NPs, Indianapolis IN
Wen's group had a Nuance DAX demo and was quoted around $4,800 per clinician per year on a 24-month contract through their hospital affiliate. They piloted PatientNotes for 60 days first and the partners voted to keep it. They built a shared transplant template that puts tacrolimus trough, MMF dose, BK and CMV PCR results in the same anchor block on every visit, which cut handoff confusion when partners cross-cover. The group also moved 90961 / 90962 weekly visits onto PatientNotes for consistency.
Dr. Aaron Singh
Hospital-employed transplant nephrologist, large academic system, Atlanta GA
Aaron splits his week between transplant clinic, transplant inpatient consults, and a half-day of glomerular disease referrals. The hospital had DAX rolled out for primary care and hospital medicine but had not extended it to transplant nephrology. He uses PatientNotes for outpatient transplant clinic and the glomerular disease half-day, and pastes the structured note into Epic. He estimates 60-90 minutes of saved charting per clinic day; he keeps using the system's native dictation tools for inpatient notes that need write-back.
Coming from Microsoft Dragon Medical One?
Microsoft Dragon Medical One has been the dictation standard in nephrology for two decades, especially for monthly comprehensive dialysis notes that have to satisfy the MCP audit trail. The newer Microsoft Dragon Copilot adds ambient capture on top. Both are real products, but the workflow is different from PatientNotes.
Dragon Medical One
- •Dictation: you talk to a microphone, the words appear in your dialysis or clinic EHR.
- •Mature voice profile — typically 99% accuracy after a few weeks of training.
- •$99-$200/month per clinician for Dragon Medical One; Dragon Copilot adds ambient at higher tiers ($250+).
- •Strong Epic / Acumen / CareConnect integration via the Dragon plug-in.
- •You still author the structure of the comprehensive monthly note; Dragon types it for you.
PatientNotes
- •Ambient: you talk to the patient at the chair, the comprehensive MCP note writes itself.
- •No voice training. Works on day one.
- •$50/month flat — no per-encounter fees, no enterprise minimums.
- •No EHR integration required — copy/paste workflow, ready in hours.
- •Generates the monthly comprehensive structure (subjective, exam, access, dialysis Rx, labs, A&P) for you.
How to switch in three steps
Sign up and run a parallel day
For one full clinic day or one round of dialysis visits, record encounters in PatientNotes while still using Dragon as your primary. Compare the two notes side by side at the end of the day.
Customize one nephrology template
Pick your highest-volume note (most nephrologists pick the in-center HD comprehensive 90960 note) and customize the structure so the access exam, dialysis Rx, and CKD-MBD block are in the order you already use.
Cancel Dragon when you are ready
Most nephrologists are off Dragon within 5-7 days. Keep it as a backup for the first month if you want — they do not conflict.
PatientNotes vs Nuance DAX
Nuance DAX (now part of Microsoft Dragon Copilot) is the enterprise AI scribe most often pitched to nephrology groups, especially those affiliated with large dialysis organizations like Fresenius, USRC, or DCI, or with hospital-employed transplant programs. We have lost deals to DAX and we have won deals against DAX. Here is the honest read for nephrology.
| Feature | PatientNotes | Nuance DAX |
|---|---|---|
| Monthly price (per clinician) | $50 | $250-$400 |
| Setup time | Same day | 8-12 weeks (Epic / Acumen / CareConnect interface) |
| Contract | Month-to-month | Typically 12-24 month minimum |
| Nephrology templates | CKD, in-center HD MCP, PD, transplant, GN, AKI | Available, often custom-built per practice with paid implementation |
| Kt/V, URR, access exam capture | Yes | Yes |
| Transplant immunosuppression tracking | Yes | Yes |
| EHR write-back (Epic / Acumen) | Copy/paste | Direct integration available |
| Best fit | Independent / group / non-affiliated dialysis rounds, 1-30 clinicians | Hospital-employed transplant programs already in Epic + DAX ecosystem |
If your hospital or large dialysis organization has already paid for DAX and integrated it into Epic, Acumen, or CareConnect, use what you have. The marginal benefit of switching is small. If you are independent, in a small/mid-size nephrology group, or rounding under your own contract at a non-corporate dialysis unit, PatientNotes is almost always the right answer — the price difference alone funds another half-day of MA support.
Frequently Asked Questions
Real questions from nephrology onboarding calls.
Does PatientNotes work for nephrology?
Yes. PatientNotes is used by general nephrologists, transplant nephrologists, and dialysis-rounding clinicians. The model is tuned for nephrology language, so it correctly captures CKD staging by eGFR (G1-G5) and albuminuria (A1-A3 from UACR), CKD-MBD parameters (calcium, phosphorus, intact PTH, vitamin D 25-OH), dialysis adequacy (Kt/V, URR, single-pool vs equilibrated), access surveillance (AVF/AVG flow and recirculation, catheter site exam), and transplant immunosuppression (tacrolimus trough, MMF dose, prednisone taper). It outputs SOAP notes for clinic, the monthly capitated payment (MCP) note for in-center hemodialysis, and consult letters back to the referring PCP, cardiologist, or endocrinologist.
How much does an AI scribe cost for nephrology?
PatientNotes is $50 per clinician per month, billed monthly with no per-encounter or per-dialysis-visit fees. Nuance DAX (now part of Microsoft Dragon Copilot) typically runs $250-$400 per clinician per month for nephrology, often with a 12-month enterprise contract through the dialysis organization or hospital system. For a nephrologist rounding on a 60-patient ESRD panel four times a month, that is roughly $2,400-$4,200 per year per provider — meaningful when the MCP reimbursement structure (CPT 90960-90962) is already tightly controlled.
Is Nuance DAX better than PatientNotes for nephrology?
DAX is a mature enterprise product with deep Epic integration, which matters when your dialysis unit shares a chart with the hospital and the workflow has to write back into Epic Tapestry or Stork. PatientNotes is materially cheaper, deploys the same day, and produces equivalent-quality nephrology notes in the side-by-side reviews we run with practicing nephrologists. If you are in a hospital-employed group already paying for DAX, use what you have. If you are in a private nephrology practice, a small dialysis joint-venture, or rounding for DCI/USRC/Fresenius without a corporate scribe contract, PatientNotes is almost always the better fit on price and time-to-value.
Can nephrology-specific notes be auto-generated?
Yes. PatientNotes ships with nephrology templates for CKD clinic follow-up, in-center hemodialysis monthly visit (the comprehensive MCP note), peritoneal dialysis follow-up, transplant 1-month / 3-month / annual visits, glomerular disease workup, AKI consult, and electrolyte consult (hyponatremia, hyperkalemia, acid-base). You can customize templates so the assessment always opens with stage and trajectory ("CKD G3bA2, eGFR slope -3 mL/min/year"), then mineral and bone, then anemia, then access — the order most nephrology practices already use.
Does it integrate with Epic, Acumen, and CareConnect for nephrology?
PatientNotes works alongside Epic (including Epic Tapestry for value-based care and Stork for hospitalists), Acumen Nephrology Advantage (the dominant outpatient nephrology EHR), CareConnect (Fresenius), eCube Clinicals (DCI), athenahealth, and any custom dialysis charting system. The note is generated in PatientNotes and pasted or copied in using a one-click copy. We do not require a write-back integration, which is what lets us deploy in a day instead of the 8-12 weeks an Epic App Orchard or Acumen interface project usually takes.
Will it help me bill nephrology CPT correctly?
PatientNotes suggests E&M codes (99213-99215) for clinic based on documented MDM (medical decision making), and surfaces the nephrology-specific monthly capitated payment codes correctly: 90960 (ESRD-related services, age 20+, four visits/month with full exam), 90961 (2-3 visits/month), 90962 (1 visit/month), 90963-90966 (pediatric and home dialysis), and 90945-90947 for non-ESRD dialysis. It also flags 90951-90959 for younger patients and 90989/90993 for transient/training visits. You review and confirm — there is no auto-billing.
How do I switch from Dragon Medical One to PatientNotes?
Three steps. First, sign up at patientnotes.ai and complete the 5-minute clinician onboarding. Second, run PatientNotes in parallel with Dragon for one full clinic day or one round of dialysis visits — record the encounter in PatientNotes, then dictate with Dragon as you normally would. Compare the two notes side by side. Third, when ready, retire Dragon. Most nephrologists make the switch in under a week. Dragon is dictation; PatientNotes is ambient — the bedside conversation at the dialysis chair becomes the monthly comprehensive note automatically, including the four-visit attestation that 90960 requires.
Is it HIPAA compliant for nephrology?
Yes. PatientNotes is HIPAA compliant, signs a Business Associate Agreement (BAA) with every practice and dialysis organization on request, and encrypts audio and notes at rest and in transit. Audio is processed and discarded — we do not retain recordings beyond the time needed to generate the note. Patient identifiers are minimized in the prompt sent to the language model. We do not train models on your data. Practices that already cleared their dialysis-organization compliance review have onboarded PatientNotes with no separate IT escalation in most cases.
Finish the comprehensive monthly note before you reach the next chair.
Nephrologists on PatientNotes save 60-90 minutes of charting per clinic day and 90+ minutes per dialysis rounding day — the difference between dinner with the family and signing notes from the parking lot.
No credit card required. $50/month after trial. Cancel anytime.