CPT® Code 90997

Official Description

Hemoperfusion (eg, with activated charcoal or resin)

Common Language Description

A hemoperfusion procedure, as defined by CPT® Code 90997, involves the use of activated charcoal or resin to effectively remove harmful substances from the bloodstream. This medical intervention is particularly crucial for patients who have ingested drugs, poisons, or other toxic agents that pose a risk to kidney function. Additionally, hemoperfusion serves to eliminate waste products from the blood in individuals suffering from kidney disease, thereby aiding in the management of their condition. Furthermore, this procedure is utilized as a supportive treatment for patients with liver failure, especially in the context of liver transplantation, both prior to and following the surgical procedure. Hemoperfusion is distinguished from other blood filtration techniques, such as hemodialysis, by its ability to process a larger volume of blood—exceeding 300 mL per minute—making it a more efficient option for toxin clearance. The procedure involves the placement of two catheters in the patient's arm: one catheter is inserted into an artery, while the other is positioned in a nearby vein. These catheters are connected via plastic tubing, facilitating the removal of blood from the body. The extracted blood is then directed through a specialized hemoperfusion system, where it flows over a column or cartridge filled with activated charcoal or resin. This system effectively traps toxic molecules or particles, resulting in cleansed blood that is subsequently returned to the body through the venous access site.

1. Indications

The hemoperfusion procedure is indicated for several specific clinical scenarios, particularly when there is a need to remove toxic substances from the bloodstream. The following conditions warrant the use of this procedure:

Drug Overdose The procedure is performed to eliminate drugs that have been ingested in excessive amounts, which can be harmful to the body.
Poisoning Hemoperfusion is indicated for patients who have been exposed to toxic substances or poisons that require rapid removal from the blood.
Kidney Disease It is utilized to remove waste products from the blood in patients suffering from kidney dysfunction or failure.
Liver Failure The procedure provides supportive treatment for patients with liver failure, particularly in preparation for or recovery from liver transplantation.

2. Procedure

The hemoperfusion procedure involves several critical steps to ensure effective toxin removal from the blood. The following outlines the procedural steps:

Step 1: Catheter Placement Two catheters are carefully inserted into the patient's arm. One catheter is placed in an artery to facilitate the withdrawal of blood, while the second catheter is positioned in a nearby vein to allow for the return of cleansed blood.
Step 2: Blood Withdrawal Blood is drawn from the body through the arterial catheter. This blood is then directed through a series of plastic tubing that connects to the hemoperfusion system.
Step 3: Hemoperfusion System Operation The extracted blood is passed over a specialized column or cartridge that contains activated charcoal or resin. This component of the system is crucial as it captures and traps toxic molecules or particles present in the blood.
Step 4: Blood Cleansing As the blood flows through the hemoperfusion system, the activated charcoal or resin effectively removes the harmful substances, resulting in cleansed blood.
Step 5: Blood Return The purified blood is then returned to the patient's body through the venous catheter, completing the hemoperfusion process.

3. Post-Procedure

After the hemoperfusion procedure, patients are typically monitored for any potential complications or adverse reactions. It is essential to assess the patient's vital signs and overall condition to ensure stability. Depending on the underlying reason for the hemoperfusion, additional supportive care may be required. Patients may also need follow-up evaluations to determine the effectiveness of the procedure and to plan any further treatment or interventions as necessary. Recovery time can vary based on the individual patient's health status and the complexity of their condition.

Short Descr	HEMOPERFUSION
Medium Descr	HEMOPERFUSION
Long Descr	Hemoperfusion (eg, with activated charcoal or resin)
Status Code	Active Code
Global Days	000 - Endoscopic or Minor Procedure
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	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)	P9A - Dialysis services (Medicare Fee Schedule)
MUE	1
CCS Clinical Classification	91 - Peritoneal dialysis

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.