AHA Coding Clinic® for HCPCS - 2003 Issue 1

Billing for outpatient renal dialysis

Under the outpatient prospective payment system (OPPS) Medicare normally does not allow payment for routine dialysis treatments furnished to end stage renal disease (ESRD) patients in the outpatient department of a hospital that does not have a certified dialysis facility. The OPPS rule for 2003 allows payment for non-routine dialysis treatments furnished in the outpatient department of a non-certified hospital dialysis facility, when the patient cannot obtain his or her regularly scheduled dialysis treatment at a certified ESRD facility. Payment for patients receiving unscheduled ESRD dialysis is limited to the following circumstances: Dialysis performed following, or in connection with...

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