Knowledge Base Article

Question:
Can a Medicare patient come to a hospital to receive a blood transfusion and get their dialysis?  Does the hospital have to be an accredited dialysis center to perform this procedure?

Answer:
When you bill HCPCS code G0257, that code tells Medicare that you provided dialysis in a hospital outpatient department that is not certified as an ESRD facility.

And one of the criteria for coverage of G0257 is when dialysis is done in conjunction with blood transfusion. 

Remember, when you bill G0257 you cannot separately bill injections, infusions, or the blood transfusion provided during that dialysis session.

Here is the link to the July 2008 OPPS update where this was last discussed, and also pasted below is the excerpted paragraph from that transmittal.

http://www.cms.hhs.gov/transmittals/downloads/R1536CP.pdf

"8. Hospital Services for Patients with End Stage Renal Disease

CMS is revising the Medicare Claims Processing Manual, Pub. 100-04, Chapter 4, §200.2 to expand the circumstances under which payment may be made to a hospital for unscheduled outpatient dialysis provided to an ESRD patient. The first circumstance listed is "dialysis performed following or in connection with a vascular access procedure". We are expanding this to include any dialysis related procedure such as vascular access procedures or blood transfusions."