CPT® Code 90968

Official Description

End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 2-11 years of age

Common Language Description

End-stage renal disease (ESRD) services encompass a range of medical interventions and management strategies aimed at patients suffering from severe kidney dysfunction. Specifically, CPT® Code 90968 pertains to the provision of these services on a daily basis for pediatric patients aged 2 to 11 years when the duration of dialysis treatment is less than a full month. This situation may arise due to various factors, such as the patient's hospitalization or the initiation of dialysis services occurring after the beginning of the month. The physician plays a critical role in establishing the dialysis regimen, which includes evaluating the patient’s condition and managing any related health issues. This ongoing oversight ensures that the dialysis treatment is tailored to the patient's needs, with adjustments made as necessary based on the patient's response to treatment. The physician also conducts regular assessments to monitor the patient's overall health, including weight management, dietary recommendations, and the administration of renal-specific nutritional supplements. Furthermore, the physician coordinates care with other healthcare professionals, addressing any developmental concerns and providing necessary referrals for additional support. The services rendered under this code are specifically designed to meet the unique needs of younger patients, ensuring comprehensive care that addresses both their medical and developmental requirements.

1. Indications

The following indications are explicitly associated with the use of CPT® Code 90968 for end-stage renal disease (ESRD) related services:

Age Group: This code is specifically for patients aged 2 to 11 years who require dialysis services.
Less than Full Month of Service: The procedure is indicated when dialysis services are provided for less than a full month, which may occur due to inpatient hospitalization or the initiation of services after the first of the month.

2. Procedure

The procedural steps involved in the application of CPT® Code 90968 are as follows:

Establishing the Dialysis Cycle: The physician begins by determining the appropriate dialysis regimen tailored to the patient's specific medical needs. This includes selecting the type of dialysis and the frequency of treatments based on the patient's condition.
Outpatient Evaluation and Management: The physician conducts outpatient evaluation and management services related to the dialysis. This involves assessing the patient's health status, reviewing laboratory data, and monitoring any existing or potential medical problems that may arise during treatment.
Patient Monitoring: Continuous oversight of the patient during dialysis is essential. The physician monitors the patient's vital signs, weight, and overall response to treatment, making necessary adjustments to the dialysis prescription as required.
Diet and Fluid Management: The physician provides dietary recommendations and monitors the patient's fluid intake to ensure optimal health outcomes. This may include prescribing special renal supplement formulas to meet the patient's nutritional needs.
Coordination of Care: The physician coordinates care with other healthcare providers, which may involve social services, nutritional support, and planning for potential kidney transplant options. This holistic approach ensures comprehensive management of the patient's health.
Developmental Interventions: For younger patients, the physician initiates interventions to address any delays in growth or development, which may include the administration of growth hormones as needed.
Parental Counseling: The physician engages with the parents or caregivers, providing counseling and addressing any questions or concerns they may have regarding the patient's treatment and overall health.

3. Post-Procedure

Post-procedure care for patients receiving services under CPT® Code 90968 includes ongoing monitoring and follow-up evaluations to assess the patient's response to dialysis. The physician continues to review laboratory results and adjust treatment plans as necessary. Additionally, the physician remains available for telephone follow-ups to address any emerging issues or concerns. It is crucial to ensure that the patient is supported in their overall health and development, with referrals made to specialists as needed for any identified behavioral or school-related problems. The comprehensive management approach aims to facilitate the best possible outcomes for the patient during their treatment for end-stage renal disease.

Short Descr	ESRD SVC PR DAY PT 2-11
Medium Descr	ESRD RELATED SVC
Long Descr	End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 2-11 years of age
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.
CR	Catastrophe/disaster related
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service