Wiki G0257

[alisonbee]

G0257--Unscheduled or emergency treatment for dialysis for ESRD patient in the outpatient department of a hospital that does not have a certified ESRD facility. This new code is assigned to APC 0170, with status indicator (SI) "S".

1- Chronic peritoneal dialysis patient in the ED for another issue
2 - Patient performs peritoneal dialysis with the assistance of the ED RN. Hospital supplies are utilized.

Does this scenario qualify for the use of G0257? Is the intent of G0257 only for hemodialysis patients?

Any comments or reference are welcome.

Thanks for your input.

 

[Mojo]

Hi Alison:

Does the patient visit meet the following criteria per CMS?

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 would otherwise have to be admitted as inpatients in order for the hospital to receive payment.


As a dialysis treatment performed at home, I don't see this PD as missing a regularly scheduled dialysis treatment that cannot be rescheduled. My thoughts are to charge for the supplies and the appropriate E/M level.

Anyone else?

 

[Treavis]

So is the G0257 only for hospitals to get reimbursed if the criteria is met? Can this code be used for the professional side?