CPT® Code 90959

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 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 specialized medical services provided to patients aged 12 to 19 years who are experiencing the advanced stages of kidney failure. These services are crucial for managing the complex needs of adolescents undergoing dialysis treatment. The primary focus of these services includes monitoring the adequacy of nutrition, which is vital for maintaining the health and well-being of young patients, as their nutritional requirements can significantly differ from those of adults. Additionally, the assessment of growth and development is a key component, as adolescents are in a critical phase of physical and emotional development. The healthcare provider plays an essential role in counseling parents, addressing their concerns, and providing guidance on managing their child's condition. The physician or other qualified healthcare professional is responsible for establishing the dialysis regimen, which includes evaluating and managing the patient's health in relation to the dialysis process. This involves regular examinations to identify any existing or potential medical issues, as well as responding to new symptoms or complications that may arise. The healthcare provider ensures that dialysis treatments are administered according to the prescribed plan and makes necessary adjustments based on the patient's ongoing needs. This includes monitoring the patient's weight, providing dietary recommendations, and prescribing specialized renal nutritional supplements when required. Furthermore, the healthcare professional reviews laboratory data to track the patient's health status and adjusts medications and nutritional supplements as needed. Interventions may be initiated to address any delays in growth or development, which could involve the administration of growth hormones. Social development is also monitored, with attention given to any behavioral or academic challenges the patient may face. Overall, these ESRD-related services are comprehensive and are encapsulated in a single code, which is reported once per month, reflecting the complexity and ongoing nature of care required for adolescents with end-stage renal disease.

1. Indications

The following indications are explicitly provided for the performance of end-stage renal disease (ESRD) related services for patients aged 12-19 years:

Monitoring for Adequacy of Nutrition This involves assessing the patient's dietary intake and nutritional status to ensure they are receiving the necessary nutrients to support their health during dialysis.
Assessment of Growth and Development Regular evaluations are conducted to monitor the physical and emotional growth of the adolescent patient, ensuring they are developing appropriately for their age.
Counseling of Parents Parents and caregivers receive guidance and support regarding the management of their child's condition, addressing any questions or concerns they may have.

2. Procedure

The procedure for providing ESRD related services includes the following steps:

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 The healthcare provider conducts regular outpatient evaluations to assess the patient's overall health, monitor for any complications, and manage ongoing treatment related to dialysis.
Routine Patient Examination The patient is examined on a routine basis to identify any existing medical problems and to address new symptoms or issues that may arise during the treatment period.
Monitoring of Dialysis Services The healthcare provider ensures that dialysis services are being delivered as prescribed, making necessary adjustments to the treatment plan based on the patient's response and needs.
Weight Monitoring and Dietary Recommendations The patient's weight is closely monitored, and dietary recommendations are provided to optimize nutrition and fluid intake, which are critical for managing ESRD.
Prescription of Nutritional Supplements Special renal supplement formulas may be prescribed as needed to support the patient's nutritional requirements during dialysis.
Review of Laboratory Data Laboratory results are reviewed regularly to track the patient's health status and to inform any necessary changes in treatment or medication.
Monitoring of Medications and Nutritional Supplements The healthcare provider monitors the effectiveness of medications and nutritional supplements, making adjustments as necessary to ensure optimal patient care.
Interventions for Growth or Development Delays If delays in growth or development are identified, appropriate interventions, such as the injection of growth hormones, may be initiated to support the patient's development.
Social Development Monitoring The healthcare provider monitors the patient's social development and addresses any behavioral or school-related issues that may arise.

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 adjust the treatment plan as necessary. Regular follow-up visits are essential to ensure that the patient is responding well to dialysis and that any emerging issues are promptly addressed. Parents and caregivers are encouraged to maintain open communication with the healthcare team, allowing for timely interventions and support as needed. The comprehensive nature of these services aims to promote the overall well-being of the adolescent patient throughout their treatment journey.

Short Descr	ESRD SERV 1 VST P MO 12-19
Medium Descr	ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT
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 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)

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.
AF	Specialty physician
GC	This service has been performed in part by a resident under the direction of a teaching physician
GW	Service not related to the hospice patient's terminal condition