CPT® Code 90951

Official Description

End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month

Common Language Description

End-stage renal disease (ESRD) related services encompass a comprehensive range of medical care provided to patients suffering from severe kidney dysfunction, specifically tailored for those younger than 2 years of age. These services are delivered on a monthly basis in an outpatient setting and are designed to ensure the overall health and well-being of the child. The primary focus of these services includes monitoring the adequacy of nutrition, which is crucial for the growth and development of young patients, as well as assessing their physical and developmental milestones. Additionally, counseling for parents is an integral part of the care process, providing them with the necessary support and information to manage their child's condition effectively. The physician or other qualified healthcare professional plays a vital role in establishing the dialysis regimen, conducting evaluations and management services related to the dialysis, and overseeing the patient's care throughout the month. This includes routine examinations to identify any existing or potential medical issues, as well as addressing new symptoms or problems as they arise. The healthcare provider ensures that dialysis services are administered according to the prescribed plan and makes necessary adjustments based on the patient's condition, which may involve monitoring weight, recommending dietary changes, and prescribing specialized renal nutritional supplements. Furthermore, the healthcare professional reviews laboratory data, monitors medications and nutritional supplements, and implements interventions for any delays in growth or development, which may include the administration of growth hormones. Social development is also monitored, with attention given to any behavioral or educational challenges the child may face. Throughout this process, the physician or healthcare professional provides ongoing counseling to parents and caregivers, addressing their concerns and questions. The services associated with ESRD are encapsulated in a single code, which is reported once per month, contingent upon the number of face-to-face visits conducted during that period.

1. Indications

The following indications outline the specific circumstances under which end-stage renal disease (ESRD) related services are performed for patients younger than 2 years of age:

End-Stage Renal Disease (ESRD) Diagnosis of ESRD requiring ongoing management and monitoring.
Age Requirement Services are specifically for patients who are younger than 2 years of age.
Nutritional Monitoring Need for assessment of nutritional adequacy to support growth and development.
Growth and Development Assessment Requirement for regular evaluation of physical and developmental milestones.
Parental Counseling Need for guidance and support for parents or caregivers regarding the management of the child's condition.

2. Procedure

The procedure for providing ESRD related services involves several key steps that ensure comprehensive care for the patient:

Establishment of Dialysis Cycle The physician or qualified healthcare professional establishes the appropriate dialysis cycle tailored to the patient's needs, ensuring that the treatment is effective and safe.
Outpatient Evaluation and Management Regular outpatient evaluations are conducted to assess the patient's health status, including monitoring for any existing or potential medical problems that may arise during the month.
Face-to-Face Visits The patient is seen for a minimum of four face-to-face visits per month, allowing for direct assessment and management of the patient's condition, as well as addressing any new symptoms or issues that may develop.
Monitoring of Dialysis Services The healthcare provider ensures that dialysis services are being delivered as prescribed, making necessary adjustments to the dialysis prescription based on the patient's response and condition.
Weight Monitoring and Dietary Recommendations The patient's weight is closely monitored, and dietary recommendations are made to optimize nutrition and fluid intake, which are critical for managing ESRD.
Laboratory Data Review Laboratory results are reviewed regularly to assess the patient's biochemical status and to guide treatment decisions.
Medication and Nutritional Supplement Monitoring Medications and nutritional supplements are monitored for efficacy and safety, with adjustments made as necessary to meet the patient's needs.
Interventions for Growth Delays If delays in growth or development are identified, appropriate interventions are initiated, which may include the administration of growth hormones.
Social and Behavioral Monitoring The healthcare provider monitors the child's social development and addresses any behavioral or educational challenges that may arise.
Parental Counseling Ongoing counseling is provided to parents and caregivers, ensuring they are informed and supported in managing their child's ESRD.

3. Post-Procedure

Post-procedure care for patients receiving ESRD related services includes continued monitoring and support. The healthcare provider will maintain regular follow-up visits to assess the patient's ongoing health status and to make any necessary adjustments to the treatment plan. Parents and caregivers are encouraged to communicate any concerns or changes in the child's condition, and the healthcare team will provide guidance on managing the child's dietary and fluid intake. Additionally, the healthcare provider will continue to monitor the child's growth and development, addressing any emerging issues promptly. This comprehensive approach ensures that the child receives the necessary support and care throughout their treatment for ESRD.

Short Descr	ESRD SERV 4 VISITS P MO <2YR
Medium Descr	ESRD RELATED SVC MONTHLY & <2 YR OLD 4/> VISITS
Long Descr	End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
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	Items and Services Not Billable to the MAC
Type of Service (TOS)	1 - Medical Care
Berenson-Eggers TOS (BETOS)	P9A - Dialysis services (Medicare Fee Schedule)
MUE	1
CCS Clinical Classification	227 - Other diagnostic procedures (interview, evaluation, consultation)