How To Use CPT Code 90935

CPT 90935 is a code for hemodialysis procedure with a single evaluation by a physician or other qualified health care professional. This article will cover the description, procedure, qualifying circumstances, when to use, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90935.

1. What is CPT 90935?

CPT 90935 is a code used to report a hemodialysis procedure that includes a single evaluation by a physician or other qualified health care professional. Hemodialysis is a treatment for patients with kidney failure, where the blood is filtered through a dialyzer to remove waste and excess fluids before being returned to the body. This code is used for inpatient and outpatient dialysis services and includes an evaluation and management (E/M) service related to the hemodialysis procedure provided on the same day.

2. 90935 CPT code description

The official description of CPT code 90935 is: “Hemodialysis procedure with single evaluation by a physician or other qualified health care professional.”

3. Procedure

The 90935 procedure involves the following steps:

1. The patient is prepared for the hemodialysis treatment, which may include checking vital signs, weight, and ensuring the access site is clean and functional.
2. The physician or qualified health care professional connects the patient to the hemodialysis machine using an intra-arterial or intravenous catheter.
3. Blood is drawn from the patient’s body and passed through the dialyzer, where waste and excess fluids are removed.
4. The filtered blood is returned to the patient’s body.
5. The physician or qualified health care professional monitors the patient throughout the procedure, making adjustments as necessary to ensure optimal treatment.
6. An E/M service related to the hemodialysis procedure is provided by the physician or qualified health care professional on the same day.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 90935 services are those with end-stage renal disease (ESRD), inpatient non-ESRD, or outpatient non-ESRD who require hemodialysis treatment. The physician or other qualified health care professional must perform the hemodialysis procedure and provide an E/M service related to the dialysis on the same day for the code to be applicable.

5. When to use CPT code 90935

It is appropriate to bill the 90935 CPT code when a physician or other qualified health care professional performs a hemodialysis procedure and provides an E/M service related to the dialysis on the same day. This code is used for inpatient ESRD, inpatient non-ESRD, and outpatient non-ESRD dialysis services. Modifier 25 can be used with a separately identifiable E/M service unrelated to the hemodialysis procedure provided on the same day.

6. Documentation requirements

To support a claim for CPT 90935, the following information should be documented:

• Patient’s diagnosis and medical necessity for hemodialysis treatment.
• Date and time of the hemodialysis procedure.
• Details of the hemodialysis procedure, including the type of access used, duration of treatment, and any complications or interventions during the procedure.
• Results of any laboratory tests or imaging studies related to the hemodialysis treatment.
• Details of the E/M service provided on the same day, including the patient’s history, physical examination, and medical decision-making.
• Any additional E/M services unrelated to the hemodialysis procedure, if applicable, with the use of Modifier 25.

7. Billing guidelines

When billing for CPT code 90935, it is important to follow the appropriate guidelines and rules. Only one E/M service related to the hemodialysis procedure can be reported with this code. If a separately identifiable E/M service unrelated to the hemodialysis procedure is provided on the same day, Modifier 25 should be used. Ensure that all documentation requirements are met to support the claim and avoid potential denials or audits.

8. Historical information

CPT 90935 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2013, with the previous descriptor being “Hemodialysis procedure with single physician evaluation.”

9. Similar codes to CPT 90935

Five similar codes to CPT 90935 and how they differentiate are:

• CPT 90937: This code is for hemodialysis procedures that include repeated evaluations by a physician or other qualified health care professional.
• CPT 90945: This code is for a dialysis procedure other than hemodialysis (e.g., peritoneal dialysis) with a single evaluation by a physician or other qualified health care professional.
• CPT 90947: This code is for a dialysis procedure other than hemodialysis with repeated evaluations by a physician or other qualified health care professional.
• CPT 90960: This code is for the management of ESRD patients who require chronic hemodialysis treatment, including monthly face-to-face visits with a physician or other qualified health care professional.
• CPT 90961: This code is for the management of ESRD patients who require chronic hemodialysis treatment, including monthly face-to-face visits with a physician or other qualified health care professional, but with fewer than the required number of visits for CPT 90960.

10. Examples

Here are 10 detailed examples of CPT code 90935 procedures:

1. A patient with ESRD undergoing inpatient hemodialysis treatment, with a single evaluation by the nephrologist on the same day.
2. An outpatient non-ESRD patient receiving hemodialysis treatment for acute kidney injury, with a single evaluation by the nephrologist on the same day.
3. A patient with ESRD undergoing inpatient hemodialysis treatment, with a single evaluation by a nurse practitioner on the same day.
4. An outpatient non-ESRD patient receiving hemodialysis treatment for drug overdose, with a single evaluation by the nephrologist on the same day.
5. A patient with ESRD undergoing inpatient hemodialysis treatment, with a single evaluation by a physician assistant on the same day.
6. An outpatient non-ESRD patient receiving hemodialysis treatment for severe electrolyte imbalance, with a single evaluation by the nephrologist on the same day.
7. A patient with ESRD undergoing inpatient hemodialysis treatment, with a single evaluation by the nephrologist and a separately identifiable E/M service unrelated to the hemodialysis procedure on the same day (using Modifier 25).
8. An outpatient non-ESRD patient receiving hemodialysis treatment for rhabdomyolysis, with a single evaluation by the nephrologist on the same day.
9. A patient with ESRD undergoing inpatient hemodialysis treatment, with a single evaluation by the nephrologist and management of a complication during the procedure.
10. An outpatient non-ESRD patient receiving hemodialysis treatment for lupus nephritis, with a single evaluation by the nephrologist on the same day.