Can G0257, Unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not a certified ESRD facility, be used for peritoneal dialysis? If not would 90945, Dialysis procedure other than hemodialysis (e.g., peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single evaluation by a physician or other qualified health care professional, be a better code to use?
Non-ESRD certified hospital outpatient facilities are to 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, for hemodialysis. Report peritoneal dialysis with CPT code 90945, Dialysis procedure other than hemodialysis (e.g. peritoneal dialysis, hemofiltration, or other continuous replacement therapies), with single physician evaluation.
Dialysis services for patients with End Stage Renal Disease (ESRD) may be reported under the Outpatient Prospective Payment System (OPPS) at a facility that is NOT a certified ESRD facility under the following limited circumstances:
- 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; or
- Emergency dialysis for ESRD patients who otherwise would have to be admitted as inpatients in order for the hospital to receive payment.