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End-stage renal disease (ESRD) related services encompass a comprehensive range of medical care provided to patients aged 12 to 19 years who are experiencing the advanced stages of kidney failure. These services are delivered on a monthly basis in an outpatient setting and are designed to address the unique needs of adolescents facing this serious health condition. The primary focus of these services includes monitoring the adequacy of nutrition, which is crucial for maintaining the overall health and well-being of the patient, as well as assessing growth and development to ensure that the patient is progressing appropriately despite their medical challenges. Additionally, counseling for parents is an integral component of the care provided, as it helps them understand the complexities of managing their child's condition and supports them in making informed decisions regarding treatment and lifestyle adjustments. The physician or other qualified health care professional plays a vital role in establishing the dialysis regimen, conducting evaluations and management services related to dialysis, and providing ongoing oversight throughout the month. This includes routine examinations to identify any existing or potential medical issues, as well as addressing new symptoms as they arise. The comprehensive nature of these ESRD services is encapsulated in a single code, which reflects the number of face-to-face visits required for effective management of the patient's condition.
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The following indications outline the specific circumstances under which end-stage renal disease (ESRD) related services are performed for patients aged 12 to 19 years:
The procedure for providing ESRD related services involves several key steps that ensure comprehensive care for the patient:
Post-procedure care for patients receiving ESRD related services includes continued monitoring of the patient's health status and ongoing support for both the patient and their family. Regular follow-up visits are essential to assess the effectiveness of the dialysis regimen, make necessary adjustments, and address any emerging health concerns. The physician remains available for telephone follow-ups as needed throughout the month, ensuring that the patient and their caregivers have access to guidance and support. Additionally, the focus on nutrition, growth, and development continues, with interventions implemented as required to promote the patient's overall well-being. This comprehensive approach aims to enhance the quality of life for adolescents with ESRD while providing the necessary medical oversight and support.
| Short Descr | ESRD SRV 4 VSTS P MO 12-19 | Medium Descr | ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/> VISITS | Long Descr | End-stage renal disease (ESRD) related services monthly, for patients 12-19 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) |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | CR | Catastrophe/disaster related | 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. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GT | Via interactive audio and video telecommunication systems | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider |
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| 2013-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Added | - |
| 1988-12-31 | Deleted | Code deleted. |
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