CPT® Code 90953

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 1 face-to-face visit by a physician or other qualified health care professional per month

Common Language Description

End-stage renal disease (ESRD) related services are critical healthcare interventions provided to patients, particularly those younger than 2 years of age, who are experiencing severe kidney dysfunction. These services are designed to ensure comprehensive management of the patient's condition on a monthly basis in an outpatient setting. The primary focus of these services includes monitoring the adequacy of nutrition, assessing the child's growth and development, and providing essential counseling to parents or caregivers. The healthcare provider, which may be a physician or another qualified health care professional, plays a vital role in establishing the dialysis regimen, conducting evaluations and management services related to the dialysis, and overseeing the patient's overall health throughout the month. This includes regular examinations to identify any existing or potential medical issues, as well as addressing new symptoms or problems as they arise. The provider is responsible for ensuring that dialysis services are delivered according to the prescribed plan, making necessary adjustments to the dialysis prescription, and monitoring the patient's weight, dietary needs, and fluid intake. Additionally, the healthcare professional may prescribe special renal supplement formulas when required. Laboratory results are reviewed to inform treatment decisions, and any medications or nutritional supplements are closely monitored for effectiveness. If there are delays in the child's growth or development, appropriate interventions, such as the administration of growth hormones, may be initiated. The provider also monitors the child's social development and addresses any behavioral or educational challenges. Throughout this process, the healthcare professional offers guidance and support to parents and caregivers, addressing their questions and concerns. The services encapsulated in this code are reported once per month, reflecting the comprehensive nature of the care provided, which includes one face-to-face visit with the healthcare provider.

1. Indications

The following indications are explicitly provided for the performance of ESRD related services for patients younger than 2 years of age:

Monitoring of Nutrition: Regular assessment of the adequacy of nutrition to ensure the child is receiving appropriate dietary support.
Growth and Development Assessment: Evaluation of the child's growth and developmental milestones to identify any delays or concerns.
Parental Counseling: Providing guidance and support to parents or caregivers regarding the child's condition and care needs.

2. Procedure

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

Establishment of Dialysis Cycle: The physician or qualified health care professional establishes the appropriate dialysis regimen tailored to the patient's specific needs, ensuring that the treatment is effective and safe.
Outpatient Evaluation and Management: The healthcare provider conducts regular outpatient evaluations to monitor the patient's health status, addressing any existing medical problems and identifying potential issues that may arise.
Routine Patient Examination: The patient is examined on a routine basis to assess their overall health and to monitor for any new symptoms or complications that may develop.
Adjustment of Dialysis Prescription: The healthcare provider makes necessary adjustments to the dialysis prescription based on the patient's response to treatment, including monitoring weight and making dietary recommendations.
Laboratory Data Review: Laboratory results are reviewed to inform treatment decisions and to ensure that the patient is responding appropriately to the prescribed therapies.
Monitoring of Medications and Nutritional Supplements: The provider closely monitors any medications and nutritional supplements the patient is receiving, making changes as needed to optimize care.
Intervention for Growth Delays: If delays in growth or development are identified, the healthcare provider may initiate interventions, such as the injection of growth hormones, to support the child's development.
Social Development Monitoring: The provider monitors the child's social development and addresses any behavioral or educational challenges that may arise.
Parental Counseling: Throughout the month, the healthcare professional provides counseling to parents and caregivers, addressing their questions and concerns regarding the child's care and condition.

3. Post-Procedure

Post-procedure care for patients receiving ESRD related services includes ongoing monitoring and support. The healthcare provider continues to evaluate the patient's health status and the effectiveness of the dialysis regimen. Regular follow-up visits are essential to ensure that the child is responding well to treatment and to make any necessary adjustments. Parents and caregivers are encouraged to maintain open communication with the healthcare provider, reporting any new symptoms or concerns that may arise. The overall goal is to ensure the child's health and well-being through comprehensive management of their condition.

Short Descr	ESRD SERV 1 VISIT P MO <2YRS
Medium Descr	ESRD RELATED SVC MONTHLY <2 YR OLD 1 VISIT
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 1 face-to-face visit 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)

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.

Clinical social worker