Corporate Compliance

Dealing with acute renal failure

Compliance Monitor, June 3, 2005

A: The patient should be transferred to an outpatient dialysis facility that can provide outpatient dialysis treatments and bill using the ICD-9 code 586 for acute renal failure. A freestanding outpatient dialysis facility should get reimbursed.

A facility can't dialyze the patient as an outpatient in the hospital and receive reimbursement unless it is certified as an outpatient dialysis provider. Even hospitals that have an outpatient dialysis provider number have trouble getting reimbursed when the patient is in acute renal failure because the intermediary believes the treatment was provided in an acute care setting even though it is billed out of their outpatient dialysis unit.

Hospital clients we have worked with that have faced this same issue have had the nephrologist complete Form 2728, Medical Evidence of Chronic Renal Failure, in order to receive reimbursement for the outpatient dialysis treatments performed in their outpatient units and then they submit information to their intermediaries if the patient's renal failure is reversed.

In summary, you need to transfer the patient to a freestanding outpatient dialysis facility. If you can't find a unit that will take the patient because of problems getting reimbursement from an intermediary when patients are "acute renal failure", then you need to ask the physician to complete the 2728.

This question was answered by the consultants at Healthcare Design Specialists.

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