Renal dialysis treatments are usually outpatient services but may be inpatient services.
A patient who is staying at his home, who is ambulatory, whose condition is stable
and who comes to the hospital for routine, chronic dialysis treatments, and not for
a diagnostic workup or a changed in therapy, is considered an outpatient. On the other
hand, a patient undergoing short-term dialysis until his kidneys recover from an acute
illness (acute dialysis), or a person with borderline renal failure who develops acute
renal failure every time he has an illness and requires dialysis (episodic dialysis),
is always an inpatient. A patient may begin dialysis as an inpatient and then progress
to an outpatient status.
If doubt exists as to a particular patient's status after these criteria are applied,
a medical opinion is obtained by the intermediary.NOTE: When patients requiring extended
care services occupy beds in a hospital, they are considered inpatients of the hospital.
In such cases, the services furnished in the hospital are not considered extended
care services, and payment may not be made under the program for such services. However,
if a bed in a participating SNF is not available, the beneficiary's continued stay
in the hospital would be medically necessary and program payment could be made.