READER QUESTIONS: Indicate Emergency Situation On Dialysis Claims

Question: Although I’m not coding for a dialysis facility, when patients are in observation and need emergent dialysis, I have to code those services. I use G0257, but am still not getting paid. Am I coding incorrectly?


Ohio Subscriber

Answer: You’re correct to  report G0257 (Unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility) for the dialysis procedure. The problem may be that you’re not using the correct revenue code or that the patient is not an end-stage renal disease (ESRD) patient. If the patient is in an observation bed when a physician performs the dialysis service, use revenue code 0760 (Treatment/observation room) or 0829 (Other outpatient hemodialysis).

You’ll also likely need to have an emergency situation revenue code, specifically code 0450 (Emergency room), on the claim and ensure the patient is not being treated for acute renal failure. 

Reasoning: The ESRD patient has to have been in an emergency situation in the emergency department, which caused the patient to miss his scheduled dialysis treatment. If you don’t include a 0450 emergency department E/M service on your claim, your fiscal intermediary will likely deny your claim.