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The CPT® Code 90937 refers to a hemodialysis procedure that necessitates repeated evaluations, which may include substantial revisions of the dialysis prescription. In this procedure, a healthcare professional, typically a nurse or technician, inserts two needles into a vascular access site that has been previously established. This access site can be an internal fistula or shunt, an internal graft, or, in less common cases, a central venous catheter. Each needle is connected to flexible plastic tubing that links to a dialysis machine. The first tube is responsible for removing blood from the patient's body, which is then circulated through the dialysis machine. During this process, the blood passes one side of a semipermeable membrane, while dialysis fluid flows on the opposite side. This setup allows for the removal of waste products and excess fluids from the blood, which then transfer through the membrane into the dialysis fluid. The cleansed blood is subsequently returned to the patient's bloodstream via the second tube. The hemodialysis procedure encompasses all evaluation and management services conducted on the same day as the dialysis treatment that are pertinent to the patient's renal disease. Specifically, when a single evaluation and management service is performed on the day of the hemodialysis, CPT® Code 90935 is utilized. In contrast, CPT® Code 90937 is applicable when multiple evaluations and management services are necessary throughout the hemodialysis session.
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The hemodialysis procedure represented by CPT® Code 90937 is indicated for patients with renal disease who require ongoing management and evaluation of their dialysis treatment. This procedure is typically performed when there is a need for adjustments to the dialysis prescription based on the patient's current health status, fluid balance, and laboratory results. The following conditions may warrant the use of this procedure:
The hemodialysis procedure involves several critical steps to ensure effective treatment and patient safety. The following outlines the procedural steps associated with CPT® Code 90937:
After the hemodialysis procedure, patients are typically monitored for any immediate complications, such as hypotension, bleeding at the access site, or signs of infection. It is essential to assess the patient's response to the treatment, including any changes in vital signs or laboratory values. Patients may experience fatigue or weakness following the procedure, which is common and usually resolves with rest. Follow-up appointments are often scheduled to evaluate the effectiveness of the dialysis treatment and to make any necessary adjustments to the dialysis prescription. Additionally, patients are advised on signs and symptoms to watch for that may indicate complications, such as increased swelling, shortness of breath, or changes in urine output.
| Short Descr | HEMODIALYSIS REPEATED EVAL | Medium Descr | HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX | Long Descr | Hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x) | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P9A - Dialysis services (Medicare Fee Schedule) | MUE | 1 | CCS Clinical Classification | 58 - Hemodialysis |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GW | Service not related to the hospice patient's terminal condition | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | FS | Split (or shared) evaluation and management visit | CS | Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system : synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | AH | Clinical psychologist | AI | Principal physician of record | AJ | Clinical social worker | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | G6 | Esrd patient for whom less than six dialysis sessions have been provided in a month | GR | This service was performed in whole or in part by a resident in a department of veterans affairs medical center or clinic, supervised in accordance with va policy | GT | Via interactive audio and video telecommunication systems | GZ | Item or service expected to be denied as not reasonable and necessary | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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