AHA Coding Clinic® for HCPCS - 2013 Issue 2

Reporting dialysis services under the outpatient prospective payment system

Under the outpatient prospective payment system (OPPS), outpatient departments of hospitals not specifically designated as end-stage renal dialysis (ESRD) facilities may perform dialysis services, bill and receive payment under the OPPS under specific circumstances only. This article will focus on the reporting of dialysis treatment in the outpatient hospital setting under OPPS for ESRD and non-ESRD patients when the circumstances are appropriate for the dialysis service provided. Reporting dialysis services under the OPPS For patients who do not have ESRD but receive dialysis in the hospital outpatient setting, report CPT code 90935, Hemodialysis procedure with single evaluation by a...

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