CPT® Code 90965

Official Description

End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 12-19 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 comprehensive range of medical care provided to patients undergoing home dialysis. Specifically, CPT® Code 90965 pertains to these services for patients aged 12 to 19 years. The primary focus of this code is to ensure that the patient receives adequate monitoring and support throughout the entire month of home dialysis treatment. This includes a thorough evaluation of the patient's nutritional needs, growth, and development, as well as providing essential counseling to parents or caregivers. The physician plays a crucial role in establishing the dialysis regimen, conducting regular outpatient evaluations, and managing any medical issues that may arise during the treatment period. Additionally, the physician is responsible for making necessary adjustments to the dialysis prescription based on the patient's ongoing needs, monitoring their weight, and advising on dietary and fluid intake. The physician also reviews laboratory data, oversees medication and nutritional supplement regimens, and initiates interventions for any growth or developmental delays. This code is specifically designed to capture the full scope of services provided in the context of home dialysis for adolescents, ensuring that all aspects of their care are addressed in a structured and age-appropriate manner.

1. Indications

The following indications are explicitly associated with the use of CPT® Code 90965 for end-stage renal disease (ESRD) related services:

Home Dialysis Services provided for patients aged 12-19 years who are undergoing home dialysis treatment.
Monitoring of Nutrition Assessment of the adequacy of nutrition to ensure the patient is receiving appropriate dietary support during dialysis.
Growth and Development Assessment Regular evaluation of the patient's growth and development to identify any potential delays or issues.
Parental Counseling Counseling of parents or caregivers to address their questions and concerns regarding the patient's treatment and overall health.

2. Procedure

The procedure associated with CPT® Code 90965 involves several critical steps to ensure comprehensive care for the patient undergoing home dialysis:

Establishment of Dialyzing Cycle The physician establishes the dialyzing cycle tailored to the individual needs of the patient, ensuring that the dialysis treatment is effective and appropriate for their condition.
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 and address any existing or potential medical problems.
Monitoring and Adjustments Throughout the month, the physician monitors the patient's weight and makes necessary adjustments to the dialysis prescription, ensuring that the treatment remains effective and safe.
Review of Laboratory Data The physician reviews laboratory data to assess the patient's health and make informed decisions regarding their treatment plan, including medications and nutritional supplements.
Interventions for Growth Delays If any delays in growth or development are identified, the physician initiates necessary interventions, which may include the administration of growth hormones or other appropriate treatments.
Behavioral and Social Monitoring The physician reviews the patient's social development and monitors for any behavioral or school-related issues, providing referrals and interventions as needed to support the patient's overall well-being.
Parental Counseling Throughout the month, the physician provides ongoing counseling to parents and caregivers, addressing their concerns and ensuring they are informed about the patient's care and treatment.

3. Post-Procedure

Post-procedure care for patients receiving ESRD-related services under CPT® Code 90965 includes continued monitoring of the patient's health and development. The physician remains available for follow-up consultations as needed, particularly if new symptoms or problems arise. Ongoing assessments of the patient's nutritional status, growth, and psychosocial development are essential to ensure that the patient is thriving while undergoing home dialysis. The physician may also provide additional resources or referrals to support the family and address any challenges that may occur during the treatment process.

Short Descr	ESRD HOME PT SERV P MO 12-19
Medium Descr	ESRD SVC HOME DIALYSIS FULL MONTH 12-19 YR OLD
Long Descr	End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 12-19 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)

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)
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