Hospital declots shunt of an ESRD patient on an outpatient basis. Since this is an ‘inpatient only’ procedure under OPPS, how does the hospital get reimbursed for the service?
ESRD Items and Services are included for payment under the Composite Rate. All other items and services included under the composite rate must be furnished by the facility, either directly or under arrangements to all of its dialysis composite rate patients. No separate payment is made for declotting of shunts and any supplies used to declot shunts. If this service was rendered under arrangements with the ESRD faciilty, the hospital should look to the ESRD facility for payment of the service. Reference: CMS Pub. 100-4, Chapter 8, section 80.
Related Questions
- Hospital declots shunt of an ESRD patient on an outpatient basis. Since this is an ‘inpatient only’ procedure under OPPS, how does the hospital get reimbursed for the service?
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