Health Information Management

Q/A: Billing outpatients for dialysis in inpatient unit

APCs Insider, July 22, 2011

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Q: Our facility has an inpatient dialysis unit, but it is not an outpatient dialysis center. On rare occasion, a patient who arrives for an outpatient procedure or is seen in the ED needs dialysis. We try to reschedule these patients in a dialysis center. However, this is sometimes not possible, but they still need to receive the treatment. Is there a way to report this service, or must we absorb the cost?

A: CMS provided a mechanism for reporting these type of nonroutine dialysis treatments in the CY 2003 OPPS final rule. In specific scenarios, you may report HCPCS code G0257 (Unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility). The Medicare Claims Processing Manual, Chapter 4-Part B Hospital (Including Inpatient Hospital Part B and OPPS), §200.2, describes these circumstances as follows:

  • Dialysis performed following or in connection with a dialysis-related procedure such as vascular access procedure or blood transfusions
  • Dialysis performed following treatment for an unrelated medical emergency; e.g., if a patient goes to the emergency room for chest pains and misses a regularly scheduled dialysis treatment that cannot be rescheduled, CMS allows the hospital to provide and bill Medicare for the dialysis treatment
  • Emergency dialysis for ESRD patients who would otherwise have to be admitted as inpatients in order for the hospital to receive payment

Report G0257 in addition to other separately reported services. Documentation should support that the patient could not be rescheduled for treatment at the patient’s usual dialysis facility or that dialysis was performed due to an emergent situation that precluded providing it at a dialysis facility.

Editor’s note: Denise Williams, RN, CPC-H, director of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Most Popular