CPT® Code 90958

Official Description

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 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 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 monitor and support the patient's nutritional needs, assess their growth and development, and provide counseling to their parents or caregivers. The physician or other qualified healthcare 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 routine examinations to identify any existing or potential medical issues, as well as addressing new symptoms or complications as they arise. The healthcare provider ensures that dialysis treatments are administered according to the prescribed plan and makes necessary adjustments based on the patient's condition, which may involve monitoring weight, advising on dietary and fluid intake, and prescribing specialized renal nutritional supplements when required. Additionally, the provider reviews laboratory results, monitors medications and nutritional supplements, and implements interventions for any growth or developmental delays, which may include the administration of growth hormones. Social and behavioral development is also assessed, with attention given to any issues related to school or behavior. Throughout this process, the physician or qualified healthcare professional offers guidance and support to parents and caregivers, addressing their inquiries and concerns. The services associated with ESRD are encapsulated within a single code, which is reported once per month, reflecting the number of face-to-face visits conducted. Specifically, CPT® Code 90958 is applicable for 2-3 face-to-face visits per month, while other codes are designated for different visit frequencies.

1. Indications

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:

Monitoring Nutritional Adequacy Regular assessment of the patient's nutritional intake to ensure it meets the requirements necessary for managing ESRD.
Assessment of Growth and Development Evaluation of the patient's physical growth and developmental milestones to identify any delays or concerns that may arise due to ESRD.
Counseling of Parents Providing support and information to parents or caregivers regarding the management of their child's condition, including addressing any questions or concerns they may have.

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 regimen tailored to the patient's specific needs, ensuring that the treatment is effective and safe.
Outpatient Evaluation and Management Conducting regular evaluations and management services related to the dialysis process, which includes monitoring the patient's health status and making necessary adjustments to the treatment plan.
Routine Examinations Performing routine examinations to identify any existing medical problems and to monitor for new symptoms or complications that may develop during the month.
Monitoring of Dialysis Services Ensuring that dialysis treatments are being administered as prescribed, with ongoing oversight to make adjustments as needed based on the patient's response to treatment.
Weight Monitoring Regularly checking the patient's weight to assess fluid retention and overall health, which is critical in managing ESRD.
Diet and Fluid Intake Recommendations Providing dietary advice and fluid intake guidelines to help manage the patient's condition effectively.
Prescription of Nutritional Supplements Prescribing special renal nutritional supplements when necessary to support the patient's dietary needs.
Review of Laboratory Data Analyzing laboratory results to monitor the patient's health and make informed decisions regarding their treatment.
Medication Monitoring Keeping track of medications and nutritional supplements, making adjustments as required to optimize the patient's care.
Interventions for Growth Delays Initiating interventions for any identified delays in growth or development, which may include the administration of growth hormones.
Social Development Monitoring Assessing the patient's social development and addressing any behavioral or school-related issues that may arise.
Parent and Caregiver Counseling Engaging with parents and caregivers to provide counseling, support, and answers to their questions 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 patient's health and well-being. This involves regular follow-up visits to assess the effectiveness of the dialysis regimen, monitor for any complications, and make necessary adjustments to the treatment plan. The healthcare provider continues to evaluate the patient's growth and development, addressing any emerging issues promptly. Additionally, the physician or qualified healthcare professional remains available for telephone follow-ups as needed, providing continuous support to the patient and their family. This comprehensive approach aims to optimize the patient's health outcomes and enhance their quality of life while managing the complexities associated with end-stage renal disease.

Short Descr	ESRD SRV 2-3 VSTS P MO 12-19
Medium Descr	ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 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 2-3 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)

59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
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.
GC	This service has been performed in part by a resident under the direction of a teaching physician
GT	Via interactive audio and video telecommunication systems