CPT® Code 90952

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 2-3 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 are specialized medical services provided to patients suffering from severe kidney dysfunction, specifically for those younger than 2 years of age. These services are crucial for managing the complex needs of infants and toddlers with ESRD, ensuring that their nutritional requirements are met, and monitoring their growth and development. The physician or qualified healthcare professional plays a vital role in establishing the dialysis regimen, which is essential for the patient's health. This includes conducting outpatient evaluations and management services that are directly related to the dialysis process. The healthcare provider is responsible for overseeing the patient's care throughout the month, which encompasses not only in-person visits but also necessary telephone follow-ups to address any emerging concerns. During these monthly services, the healthcare professional routinely examines the patient to identify any existing or potential medical issues. They are also prepared to respond to new symptoms or problems as they arise. The physician ensures that the dialysis treatment is being administered according to the prescribed plan and makes any necessary adjustments to the dialysis prescription based on the patient's condition. This includes monitoring the patient's weight, providing dietary recommendations, and prescribing specialized renal nutritional supplements when required. Additionally, the healthcare provider reviews laboratory data to track the patient's health status and monitors medications and nutritional supplements, making changes as needed to optimize the patient's care. If there are delays in the child's growth or development, appropriate interventions, such as the administration of growth hormones, may be initiated. The healthcare professional also pays attention to the child's social development and addresses any behavioral or educational challenges that may arise. Importantly, the physician or healthcare provider offers counseling to parents and caregivers, addressing their questions and concerns to support the overall well-being of the child. These comprehensive ESRD services are encapsulated in a single code, which is billed once per month, reflecting 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) The patient is diagnosed with end-stage renal disease, requiring ongoing management and monitoring.
Age Requirement The patient is younger than 2 years of age, necessitating specialized care tailored to the developmental needs of infants and toddlers.
Nutritional Monitoring There is a need for monitoring the adequacy of nutrition to ensure the patient is receiving appropriate dietary support.
Growth and Development Assessment The patient requires regular assessment of growth and development to identify any delays or issues that may arise.
Parental Counseling Parents or caregivers need counseling regarding the management of the child's condition, including addressing questions and concerns.

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 dialysis cycle tailored to the patient's specific needs, ensuring that the treatment is appropriate for their condition.
Outpatient Evaluation and Management The healthcare provider conducts outpatient evaluation and management services related to the dialysis, which includes routine examinations to monitor the patient's health status and identify any potential medical problems.
Face-to-Face Visits The patient is seen for 2 to 3 face-to-face visits per month, allowing for direct assessment and management of the patient's condition, as well as the opportunity to address any new symptoms or issues that may develop.
Monitoring of Dialysis Services The physician ensures that dialysis services are being provided as prescribed, making necessary adjustments to the dialysis prescription based on the patient's ongoing assessment.
Weight Monitoring and Dietary Recommendations The healthcare provider monitors the patient's weight and provides recommendations regarding diet and fluid intake to optimize the patient's health and manage their condition effectively.
Prescription of Nutritional Supplements If needed, the physician prescribes special renal supplement formulas to support the patient's nutritional needs.
Laboratory Data Review The healthcare provider reviews laboratory data to track the patient's health and make informed decisions regarding their care.
Medication and Supplement Monitoring Medications and nutritional supplements are monitored closely, with adjustments made as necessary to ensure the patient's well-being.
Interventions for Growth Delays If there are delays in growth or development, the physician initiates appropriate interventions, which may include the injection of growth hormones.
Social Development Monitoring The healthcare provider monitors the child's social development and addresses any behavioral or school-related problems that may arise.
Parental Counseling The physician or healthcare professional provides counseling to parents and caregivers, responding to their questions and concerns to support the overall management of the child's condition.

3. Post-Procedure

Post-procedure care for patients receiving ESRD related services includes ongoing monitoring and support to ensure the child's health and development are adequately addressed. The healthcare provider continues to evaluate the patient's condition through regular follow-up visits, which may include additional face-to-face consultations as needed. The physician remains available for telephone follow-ups to address any emerging concerns or questions from parents or caregivers. Continuous assessment of the patient's growth, nutritional status, and overall well-being is essential, with adjustments to the treatment plan made as necessary. The healthcare provider also maintains communication with the family to provide guidance and support throughout the management of the child's ESRD.

Short Descr	ESRD SERV 2-3 VSTS P MO <2YR
Medium Descr	ESRD RELATED SVC MONTHLY <2 YR OLD 2/3 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 2-3 face-to-face visits by a physician or other qualified health care professional per month
Status Code	Carriers Price the 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)