CPT® Code 90989

Official Description

Dialysis training, patient, including helper where applicable, any mode, completed course

Common Language Description

The CPT® Code 90989 refers to the process of dialysis training for patients, which may also include assistance from a helper when necessary. This training encompasses a comprehensive course that is completed by the patient, focusing on self-dialysis techniques. The physician plays a crucial role in this training by providing a range of administrative and professional services. These services include the supervision and direction of the patient during the self-dialysis training, ensuring that the patient and any involved helpers are adequately prepared and informed. The physician's responsibilities extend to training and supervising the staff involved in the dialysis process, participating in staff conferences, and managing the overall facility operations related to dialysis. Additionally, the physician advises the staff on the procurement of necessary supplies and provides medical direction to ensure that the self-training services are delivered effectively to the patient. Routine professional services performed by the physician may include directing and participating in the training of dialysis patients, assessing the patient's home environment and family situation, and counseling family members to support the patient's training. The physician also reviews the training process, evaluates laboratory results, nurses' notes, and other medical documentation, and makes necessary adjustments to the patient's medication, diet, or dialysis procedure. Furthermore, the physician prescribes medical supplies, evaluates the patient's psychosocial status, and assesses the appropriateness of the treatment being provided. Pre-dialysis and post-dialysis examinations of the patient are also part of the physician's responsibilities, culminating in the observation of a complete and successful self-dialysis procedure performed by the patient. The use of CPT® Code 90989 indicates that the patient has successfully completed the required self-dialysis training course, which typically consists of at least 25 training sessions.

1. Indications

The following indications are associated with the procedure of dialysis training as described by CPT® Code 90989:

Self-Dialysis Training This procedure is indicated for patients who are preparing to undertake self-dialysis, allowing them to manage their own treatment effectively.
Involvement of a Helper The training may also involve a helper, which is applicable for patients who require assistance during the self-dialysis process.
Patient Education The procedure is indicated for educating patients and their families about the self-dialysis process, ensuring they understand the necessary steps and precautions.

2. Procedure

The procedure for dialysis training under CPT® Code 90989 involves several key steps that ensure the patient is adequately prepared for self-dialysis:

Step 1: Initial Assessment The physician conducts an initial assessment of the patient, which includes reviewing their medical history, current health status, and any psychosocial factors that may affect their ability to perform self-dialysis. This assessment helps tailor the training to the individual needs of the patient.
Step 2: Training Sessions The training consists of a series of sessions, typically at least 25, where the physician or trained staff instructs the patient on the self-dialysis process. These sessions cover the operation of dialysis equipment, understanding the dialysis procedure, and recognizing potential complications.
Step 3: Family Involvement Family members or helpers are included in the training sessions to ensure they understand their role in supporting the patient during self-dialysis. This may involve counseling and training on how to assist the patient effectively.
Step 4: Review of Training Progress Throughout the training, the physician reviews the patient's progress, including their ability to perform the procedure independently and any challenges they may face. Adjustments to the training plan may be made based on this review.
Step 5: Final Evaluation Upon completion of the training course, the physician conducts a final evaluation to observe a complete and successful self-dialysis procedure performed by the patient. This evaluation is critical to ensure the patient is competent and confident in managing their own dialysis.

3. Post-Procedure

After the completion of the dialysis training, the patient is expected to demonstrate proficiency in self-dialysis. The physician may provide ongoing support and follow-up appointments to monitor the patient's progress and address any concerns that arise during the self-dialysis process. It is essential for the patient to have access to resources and support systems, including emergency contacts and educational materials, to ensure their safety and success in managing their treatment independently. Regular evaluations may be scheduled to assess the patient's health status and the effectiveness of the self-dialysis regimen.

Short Descr	DIALYSIS TRAINING COMPLETE
Medium Descr	DIALYSIS TRAINING PATIENT COMPLETED COURSE
Long Descr	Dialysis training, patient, including helper where applicable, any mode, completed course
Status Code	Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x)
Type of Service (TOS)	1 - Medical Care
Berenson-Eggers TOS (BETOS)	P9B - Dialysis services (Non-Medicare Fee Schedule)
MUE	1
CCS Clinical Classification	91 - Peritoneal dialysis

XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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.
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)
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