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End-stage renal disease (ESRD) related services encompass a comprehensive range of medical care provided to patients who are undergoing home dialysis. This specific CPT® code, 90966, pertains to the services rendered for a full month for patients aged 20 years and older. The physician plays a crucial role in establishing the dialyzing cycle, which is the schedule and method by which dialysis is performed at home. This includes performing outpatient evaluation and management services that are directly related to the home dialysis process. Throughout the month, the physician is responsible for overseeing and managing the patient's care during dialysis sessions, ensuring that the treatment is effective and safe. Additionally, the physician conducts routine examinations to monitor the patient for any existing or potential medical issues that may arise. If new symptoms or complications develop, the physician is available to assess and address these concerns promptly. It is essential for the physician to ensure that the dialysis services are being delivered according to the prescribed plan, making necessary adjustments to the dialysis prescription based on the patient's evolving needs. The physician also reviews laboratory data to track the patient's health status and response to treatment. Monitoring medications and nutritional supplements is another critical aspect of care, as adjustments may be required to optimize the patient's health outcomes. Furthermore, the physician coordinates comprehensive care, which may involve social service interventions, nutritional support, planning for kidney transplantation, and collaboration with other medical or surgical specialists to provide holistic care for the patient.
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The following indications are explicitly associated with the provision of end-stage renal disease (ESRD) related services for home dialysis:
The procedure for providing ESRD related services for home dialysis involves several critical steps that ensure comprehensive patient care:
Post-procedure care for patients receiving ESRD related services for home dialysis includes ongoing monitoring and follow-up to ensure the effectiveness of the treatment. The physician is responsible for assessing the patient's recovery and response to dialysis, making any necessary adjustments to the treatment plan. Regular follow-up appointments are essential to address any emerging health issues, review laboratory results, and ensure that the patient is adhering to their prescribed medication and dietary regimen. Additionally, the physician may provide education and support to the patient and their family regarding the management of ESRD and the importance of maintaining a healthy lifestyle to support kidney function.
| Short Descr | ESRD HOME PT SERV P MO 20+ | Medium Descr | ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD | Long Descr | End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 20 years of age and older | 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. | 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 | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | CR | Catastrophe/disaster related | GT | Via interactive audio and video telecommunication systems | 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. | G3 | Most recent urr reading of 65 to 69.9 | G5 | Most recent urr reading of 75 or greater | G4 | Most recent urr reading of 70 to 74.9 | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | G2 | Most recent urr reading of 60 to 64.9 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only 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 away 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 is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | FR | The supervising practitioner was present through two-way, audio/video communication technology | G1 | Most recent urr reading of less than 60 | GQ | Via asynchronous telecommunications system | KX | Requirements specified in the medical policy have been met | MC | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | UB | Medicaid level of care 11, as defined by each state | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Added | - |
| 1988-12-31 | Deleted | Code deleted. |
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