CPT® Code 90956

Official Description

End-stage renal disease (ESRD) related services monthly, for patients 2-11 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 encompass a comprehensive range of medical care provided to pediatric patients aged 2 to 11 years who are experiencing the complexities associated with ESRD. These services are delivered on a monthly basis in an outpatient setting and are designed to ensure that the nutritional needs of the patient are adequately met, while also monitoring their growth and development. The physician or other qualified health care professional plays a crucial role in establishing the dialysis regimen, conducting evaluations and management services pertinent to the dialysis process, and overseeing the patient's overall health throughout the month. This includes not only routine examinations to identify existing or potential medical issues but also the flexibility to address new symptoms or complications as they arise. The physician is responsible for ensuring that dialysis treatments are administered according to the prescribed plan, making necessary adjustments based on the patient's condition, which may involve monitoring weight, dietary recommendations, fluid intake, and the prescription of specialized renal nutritional supplements. Additionally, laboratory results are reviewed to inform treatment decisions, and any required changes to medications or nutritional supplements are implemented. The physician also initiates interventions for any delays in the patient's growth or development, which may include the administration of growth hormones when indicated. Furthermore, the social development of the patient is monitored, and any behavioral or academic challenges are addressed. Throughout this process, the physician or qualified health care professional provides counseling to parents and caregivers, addressing their inquiries and concerns. It is important to note that these ESRD services are encapsulated within 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 ESRD related services are performed for pediatric patients aged 2 to 11 years:

End-Stage Renal Disease (ESRD) Patients diagnosed with end-stage renal disease requiring ongoing management and support.
Monitoring Nutritional Adequacy Patients needing regular assessment of their nutritional status to ensure proper dietary intake.
Growth and Development Assessment Patients requiring evaluation of growth patterns and developmental milestones to identify any delays or concerns.
Parental Counseling Parents and caregivers needing guidance and support regarding the management of their 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 health care 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 Visit A minimum of one face-to-face visit is conducted each month, during which the physician examines the patient, addresses any new symptoms or issues, and provides necessary interventions.
Monitoring and Adjustments The physician monitors the patient's weight and makes dietary and fluid intake recommendations, adjusting the dialysis prescription as needed based on the patient's response to treatment.
Laboratory Data Review Laboratory results are reviewed to inform treatment decisions, ensuring that any necessary changes to medications or nutritional supplements are made promptly.
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 physician monitors the patient's social development and addresses any behavioral or academic issues that may arise, providing support as needed.
Parental Counseling Throughout the process, the physician provides counseling to parents and caregivers, addressing their questions and concerns regarding the management of their child's ESRD.

3. Post-Procedure

Post-procedure care for patients receiving ESRD related services includes ongoing monitoring and support to ensure the effectiveness of the treatment plan. Patients are expected to have regular follow-up visits to assess their health status and make any necessary adjustments to their care. The physician continues to monitor the patient's growth and development, as well as their nutritional needs, ensuring that any changes in their condition are addressed promptly. Additionally, the physician remains available for telephone follow-up as needed, providing continued support to both the patient and their caregivers. This comprehensive approach aims to optimize the patient's health outcomes and quality of life while managing the complexities associated with end-stage renal disease.

Short Descr	ESRD SRV 1 VISIT P MO 2-11
Medium Descr	ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT
Long Descr	End-stage renal disease (ESRD) related services monthly, for patients 2-11 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	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)

GC	This service has been performed in part by a resident under the direction of a teaching physician
AF	Specialty physician
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider