CPT® Code 90963

Official Description

End-stage renal disease (ESRD) related services for home dialysis per full month, 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

Common Language Description

End-stage renal disease (ESRD) related services encompass a range of medical care provided to patients undergoing home dialysis. Specifically, CPT® Code 90963 pertains to these services for patients younger than 2 years of age. The primary focus of this code is to ensure comprehensive management of the patient's condition over a full month. This includes monitoring the adequacy of nutrition, which is crucial for the growth and development of young children, as well as assessing their overall growth and developmental milestones. Additionally, the code covers counseling for parents, addressing their concerns and providing guidance on managing their child's condition. The physician plays a vital role in establishing the dialyzing cycle and performing outpatient evaluation and management services related to home dialysis. This ongoing oversight includes routine examinations to identify any existing or potential medical issues, ensuring that the dialysis services are delivered as prescribed, and making necessary adjustments to the dialysis prescription. Furthermore, the physician monitors the patient's weight, dietary needs, and fluid intake, and may prescribe special renal supplement formulas when required. Laboratory data is regularly reviewed, and any changes to medications or nutritional supplements are made as needed. The physician is also responsible for initiating interventions for any delays in growth or development, which may involve the administration of growth hormones. Social development is monitored, and referrals are made for any behavioral or school-related issues. Overall, these ESRD-related services are encapsulated in a single code, which is reported once per month, and are specifically tailored to the age of the patient, with different codes designated for various age groups.

1. Indications

The indications for CPT® Code 90963 include the following:

End-stage renal disease (ESRD) - This code is specifically used for patients diagnosed with ESRD who require home dialysis services.
Age-specific care - The services are intended for patients younger than 2 years of age, ensuring that the unique needs of this age group are met.
Monitoring of nutrition - The procedure includes monitoring the adequacy of nutrition, which is critical for the growth and development of infants and toddlers.
Assessment of growth and development - Regular assessments are performed to track the child's growth and developmental milestones.
Counseling of parents - The procedure involves counseling parents and caregivers, addressing their questions and concerns regarding the child's condition and care.

2. Procedure

The procedure for CPT® Code 90963 involves several key steps that ensure comprehensive care for the patient undergoing home dialysis:

Establishment of the dialyzing cycle - The physician establishes the appropriate dialyzing cycle tailored to the individual needs of the patient, ensuring effective dialysis treatment.
Outpatient evaluation and management - The physician performs outpatient evaluation and management services related to the home dialysis, which includes routine examinations to monitor the patient's health status.
Monitoring and adjustments - The physician monitors the patient's weight and nutritional intake, making necessary adjustments to the dialysis prescription and dietary recommendations as needed.
Review of laboratory data - Regular review of laboratory data is conducted to assess the patient's health and make informed decisions regarding medications and nutritional supplements.
Interventions for growth and development - The physician initiates interventions for any delays in growth or development, which may include the administration of growth hormones when indicated.
Social and behavioral monitoring - The physician monitors the patient's social development and addresses any behavioral or school-related issues, providing referrals and interventions as necessary.
Parent and caregiver counseling - Throughout the month, the physician provides ongoing counseling to parents and caregivers, addressing their concerns and ensuring they are informed about the child's care.

3. Post-Procedure

Post-procedure care for patients receiving services under CPT® Code 90963 includes continued monitoring of the patient's health and development. The physician will schedule follow-up appointments as needed to assess the effectiveness of the dialysis treatment and any interventions implemented. Parents and caregivers are encouraged to maintain open communication with the physician regarding any new symptoms or concerns that may arise. Additionally, ongoing support and counseling are provided to ensure that the family is equipped to manage the child's condition effectively at home. Regular assessments will continue to focus on the child's growth, nutritional needs, and overall well-being, with adjustments made to the care plan as necessary.

Short Descr	ESRD HOME PT SERV P MO <2YRS
Medium Descr	ESRD SVC HOME DIALYSIS FULL MONTH <2YR OLD
Long Descr	End-stage renal disease (ESRD) related services for home dialysis per full month, 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
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)