AHA Coding Clinic® for HCPCS - 2013 Quarter 2
Reporting dialysis services under the outpatient prospective payment system
An ESRD patient was on his way to his ESRD facility for a regularly scheduled dialysis. The patient experienced substernal chest pain and before reaching the ESRD facility, the patient stopped at the Community Hospital emergency department for care. After the patient was stabilized, the decision was made to perform the dialysis treatment at the Community Hospital, because it was not medically advisable to delay the dialysis and the patient’s regular ESRD facility had closed for the day. What codes would be assigned for the dialysis treatment? ...
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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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