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End-stage renal disease (ESRD) services encompass a range of medical interventions provided to patients suffering from severe kidney dysfunction, specifically when their kidneys can no longer adequately filter waste products from the blood. The CPT® Code 90970 specifically pertains to the daily services rendered for patients aged 20 years and older who require dialysis for less than a full month. This situation may arise due to various factors, such as the patient being hospitalized for part of the month or the initiation of dialysis services occurring after the beginning of the month. The physician plays a critical role in managing the patient's care during this period, which includes establishing the dialysis regimen, conducting evaluations and management services related to the dialysis, and providing ongoing oversight during the dialysis sessions. The physician's responsibilities extend beyond the immediate dialysis treatment; they also involve routine examinations to identify and address any existing or potential medical issues. This proactive approach ensures that the patient's overall health is monitored, and any new symptoms or complications are promptly addressed. The physician is tasked with ensuring that the dialysis treatment is administered according to the prescribed plan, making necessary adjustments to the dialysis prescription based on the patient's response and condition. In addition to monitoring the patient's weight and making dietary and fluid intake recommendations, the physician may prescribe specialized renal nutritional supplements as required. Regular review of laboratory data is essential for assessing the patient's health status, and any necessary changes to medications or nutritional support are made accordingly. The physician also coordinates comprehensive care, which may involve collaboration with social services, nutritional support, and planning for potential kidney transplant options. For younger patients, the physician is responsible for addressing growth and developmental delays, which may include administering growth hormone injections. Furthermore, the physician monitors social development and addresses any behavioral or educational challenges by making appropriate referrals. Throughout this process, the physician provides counseling to parents and caregivers, addressing their concerns and questions. The services described under CPT® Code 90970 are specifically tailored for adult patients and are billed on a daily basis, reflecting the ongoing nature of care required for those with ESRD.
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The following indications are explicitly associated with the provision of end-stage renal disease (ESRD) related services under CPT® Code 90970:
The procedural steps involved in providing ESRD related services under CPT® Code 90970 are as follows:
Post-procedure care for patients receiving ESRD related services under CPT® Code 90970 includes ongoing monitoring and evaluation of the patient's health status. The physician continues to assess the patient's response to dialysis and makes necessary adjustments to the treatment plan as required. Follow-up appointments are scheduled to ensure that the patient is progressing well and to address any emerging health issues. Additionally, the physician may provide further counseling and support to the patient and their caregivers, ensuring that they are informed and comfortable with the ongoing management of the patient's condition. This comprehensive approach is vital for optimizing patient outcomes and maintaining quality of life for individuals with end-stage renal disease.
| Short Descr | ESRD SVC PR DAY PT 20+ | Medium Descr | ESRD RELATED SVC YR OLD | Long Descr | End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; 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) |
| GW | Service not related to the hospice patient's terminal condition | 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) | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | CR | Catastrophe/disaster related | 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. | SA | Nurse practitioner rendering service in collaboration with a physician | 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 | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 27 | Multiple outpatient hospital e/m encounters on the same date: for hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct e/m encounters performed in multiple outpatient hospital settings on the same date may be reported by adding modifier 27 to each appropriate level outpatient and/or emergency department e/m code(s). this modifier provides a means of reporting circumstances involving evaluation and management services provided by physician(s) in more than one (multiple) outpatient hospital setting(s) (eg, hospital emergency department, clinic). note: this modifier is not to be used for physician reporting of multiple e/m services performed by the same physician on the same date. for physician reporting of all outpatient evaluation and management services provided by the same physician on the same date and performed in multiple outpatient setting(s) (eg, hospital emergency department, clinic), see evaluation and management, emergency department, or preventive medicine services codes. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 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. | G1 | Most recent urr reading of less than 60 | G3 | Most recent urr reading of 65 to 69.9 | G6 | Esrd patient for whom less than six dialysis sessions have been provided in a month | GT | Via interactive audio and video telecommunication systems | 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 | 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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| 2018-04-16 | Changed | Short description changed. |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Added | - |
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