CPT® Code 90993

Official Description

Dialysis training, patient, including helper where applicable, any mode, course not completed, per training session

Common Language Description

The CPT® Code 90993 refers to the process of dialysis training for patients, which may also include assistance from a helper when necessary. This training is crucial for patients who are learning to perform self-dialysis, a procedure that allows them to manage their own treatment at home. The physician plays a vital role in this training by providing a range of administrative and professional services. These services encompass the supervision and direction of the patient during the training sessions, ensuring that the patient and any helpers understand the self-dialysis process thoroughly. The physician's responsibilities include training and supervising the staff involved in the patient's care, participating in staff meetings, advising on the procurement of necessary supplies, and providing medical direction to the staff delivering the training. Additionally, the physician conducts routine professional services that are essential for the patient's successful self-dialysis. This includes assessing the patient's home environment and family dynamics, counseling family members, and reviewing the training process to ensure it meets the patient's needs. The physician also evaluates laboratory results, nurses' notes, and other medical documentation to make informed decisions regarding the patient's care. Adjustments to the patient's medication, diet, or dialysis procedure may be necessary based on these evaluations. Furthermore, the physician prescribes medical supplies and assesses the patient's psychosocial status to ensure they are mentally and emotionally prepared for self-dialysis. Pre-dialysis and post-dialysis examinations are also part of the physician's role, along with observing the patient during a complete and successful self-dialysis procedure. It is important to note that CPT® Code 90993 is specifically used when the training course is not completed, and it is billed for each training session conducted. In contrast, CPT® Code 90989 is applicable when the self-dialysis training course is completed, which typically requires at least 25 training sessions.

1. Indications

The indications for utilizing CPT® Code 90993 include the need for dialysis training for patients who are preparing to undertake self-dialysis. This training is essential for patients who require assistance in learning the self-dialysis process, ensuring they can manage their treatment effectively at home. The following conditions may warrant the use of this code:

Patient Preparation for Self-Dialysis Patients who are transitioning to self-dialysis require comprehensive training to understand the procedure and manage their treatment independently.
Involvement of a Helper When a patient has a helper, such as a family member or caregiver, who will assist in the self-dialysis process, training is necessary to ensure both the patient and helper are adequately prepared.
Assessment of Home Environment Patients with specific home environments or family dynamics that may impact their ability to perform self-dialysis may need tailored training sessions.

2. Procedure

The procedure for CPT® Code 90993 involves several key steps that ensure the patient and any involved helpers receive the necessary training for self-dialysis. The following procedural steps are outlined:

Step 1: Initial Assessment The physician begins by conducting an initial assessment of the patient’s medical history, home environment, and psychosocial status. This assessment helps identify any specific needs or concerns that may affect the training process.
Step 2: Training Session Planning Based on the initial assessment, the physician plans the training sessions, which may include scheduling multiple sessions to cover all necessary aspects of self-dialysis.
Step 3: Training Delivery During each training session, the physician provides detailed instructions on the self-dialysis procedure, including the setup, operation, and monitoring of the dialysis equipment. The physician also demonstrates the procedure and allows the patient and helper to practice under supervision.
Step 4: Review of Training Progress The physician reviews the progress of the patient and helper throughout the training sessions, providing feedback and making adjustments to the training as needed to ensure comprehension and competence.
Step 5: Documentation and Follow-Up After each session, the physician documents the training provided, including any observations made during the training. Follow-up sessions may be scheduled to reinforce learning and address any ongoing concerns.

3. Post-Procedure

Post-procedure care following the training sessions under CPT® Code 90993 involves continued support and evaluation of the patient’s ability to perform self-dialysis independently. The physician may schedule follow-up appointments to assess the patient’s progress, review any challenges encountered during self-dialysis, and make necessary adjustments to the treatment plan. Additionally, the physician may provide ongoing counseling and support to both the patient and helper to ensure a successful transition to self-dialysis. It is essential to monitor the patient’s health status and make any required modifications to their medication or dietary needs based on their experience with self-dialysis. This ongoing care is crucial for ensuring the long-term success of the self-dialysis process.

Short Descr	DIALYSIS TRAINING INCOMPL
Medium Descr	DIALYSIS TRAINING PATIENT PER TRAINING SESSION
Long Descr	Dialysis training, patient, including helper where applicable, any mode, course not completed, per training session
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

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.
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.
CR	Catastrophe/disaster related