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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Article Overview
This article discusses how dialysis services are reported in the hospital outpatient setting under the outpatient prospective payment system (OPPS). It is intended for coders, billers, and revenue cycle staff working with ESRD and non-ESRD outpatient dialysis scenarios, especially when dialysis occurs in a hospital department rather than a certified ESRD facility. The content covers general reporting circumstances, distinctions between patient types, and the kinds of situations that can affect outpatient dialysis billing under OPPS.
Why This Topic Matters
Dialysis reporting in the outpatient hospital setting can affect how services are billed and whether payment is recognized under OPPS. Understanding the article helps coding and billing staff identify when outpatient dialysis scenarios are being addressed and what broad guidance the article provides.
What You Will Learn
- How outpatient dialysis services are discussed under OPPS
- The difference between ESRD and non-ESRD outpatient dialysis reporting scenarios
- The kinds of hospital outpatient circumstances covered by the article
- Which general coding and billing topics are involved in outpatient dialysis reporting
Who Should Read This
- Medical coders
- Hospital outpatient billing staff
- Revenue cycle professionals
- Compliance staff
- Health information management professionals
Codes Discussed
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