How To Use CPT Code 90935

CPT 90935 refers to the hemodialysis procedure with a single evaluation by a physician or other qualified healthcare professional. This procedure is essential for patients with advanced kidney failure, as it involves the removal of waste products and excess fluids from the blood through a specialized machine. The process not only cleanses the blood but also allows for the monitoring and management of the patient’s overall health during the treatment. The inclusion of an evaluation and management (E/M) service on the same day enhances the comprehensive care provided to the patient undergoing hemodialysis.

1. What is CPT code 90935?

CPT code 90935 represents a specific hemodialysis procedure that is performed on patients suffering from end-stage renal disease (ESRD) or other forms of kidney dysfunction. Hemodialysis is a critical treatment modality that involves the extraction of blood from the patient, its filtration through a dialyzer—a specialized filter that removes toxins and excess fluids—and the reinfusion of the purified blood back into the patient’s body. This procedure is vital for maintaining the patient’s health, as it compensates for the kidneys’ inability to perform their natural filtering functions. The code encompasses not only the hemodialysis procedure itself but also allows for a single evaluation by a healthcare professional on the same day, ensuring that the patient’s condition is closely monitored and managed throughout the treatment process.

2. Qualifying Circumstances

This CPT code can be utilized under specific circumstances related to the patient’s condition and the nature of the hemodialysis treatment. It is appropriate for patients diagnosed with end-stage renal disease (ESRD), as well as those with non-ESRD conditions requiring dialysis. The code is applicable for both inpatient and outpatient settings. However, it is important to note that only one E/M service related to the hemodialysis procedure can be reported with this code on the same day. If additional E/M services are provided that are unrelated to the hemodialysis, modifier 25 may be used to indicate that these services are separate and distinct from the hemodialysis procedure.

3. When To Use CPT 90935

CPT code 90935 is used when a patient undergoes a hemodialysis session that includes a single evaluation by a qualified healthcare provider on the same day. This code is particularly relevant when the provider is responsible for both the administration of the hemodialysis and the assessment of the patient’s health status during the treatment. It is crucial to ensure that this code is not used in conjunction with other E/M codes for the same hemodialysis session unless they are distinctly separate services, in which case modifier 25 should be applied. The code is specifically designed for inpatient ESRD, inpatient non-ESRD, and outpatient non-ESRD dialysis services, making it a versatile option for various patient scenarios.

4. Official Description of CPT 90935

Official Descriptor: Hemodialysis procedure with single evaluation by a physician or other qualified health care professional.

5. Clinical Application

The clinical application of CPT code 90935 is centered around the hemodialysis procedure, which is a life-sustaining treatment for patients with severe kidney impairment. The procedure is performed to remove waste products, excess salts, and fluids from the blood, which are typically excreted by healthy kidneys. The importance of this service cannot be overstated, as it plays a critical role in managing the health of patients with kidney failure, preventing complications such as fluid overload, electrolyte imbalances, and toxic buildup in the body. The inclusion of an evaluation by a healthcare professional ensures that the patient’s response to treatment is monitored, and any necessary adjustments to the dialysis regimen can be made promptly.

5.1 Provider Responsibilities

The provider’s responsibilities during the hemodialysis procedure include preparing the patient for treatment, ensuring the proper functioning of the dialysis machine, and monitoring the patient’s vital signs throughout the session. The provider must also assess the patient’s overall health status, including any potential complications that may arise during the procedure. This involves checking the access site for any signs of infection or clotting, adjusting the dialysis parameters as needed, and providing education to the patient regarding their treatment plan. Additionally, the provider is responsible for documenting the procedure and any relevant findings during the evaluation.

5.2 Unique Challenges

One of the unique challenges associated with hemodialysis is managing the patient’s response to the treatment, as some individuals may experience adverse reactions such as hypotension, cramping, or allergic responses to the dialyzer. Providers must be vigilant in monitoring these potential complications and be prepared to intervene as necessary. Furthermore, the complexity of coordinating care for patients with multiple comorbidities can complicate the delivery of hemodialysis, requiring providers to collaborate closely with other healthcare professionals to ensure comprehensive management of the patient’s health.

5.3 Pre-Procedure Preparations

Before the hemodialysis procedure, the provider must conduct a thorough evaluation of the patient’s medical history, current medications, and any previous dialysis sessions. This includes assessing the patient’s access site for any issues and ensuring that the dialysis machine is properly calibrated and functioning. Additionally, the provider may need to perform laboratory tests to evaluate the patient’s electrolyte levels and overall health status, which can inform the dialysis treatment plan and help prevent complications during the procedure.

5.4 Post-Procedure Considerations

After the hemodialysis session, the provider must monitor the patient for any immediate post-treatment complications, such as hypotension or bleeding at the access site. Follow-up care may include providing instructions on managing any side effects experienced during the treatment and scheduling the next dialysis session. The provider should also review the patient’s lab results and make any necessary adjustments to the treatment plan based on the patient’s response to the dialysis. Ongoing education and support for the patient are essential to ensure adherence to the treatment regimen and to address any concerns they may have.

6. Relevant Terminology

Hemodialysis: A medical procedure that filters waste, salts, and fluids from the blood using a dialysis machine, typically for patients with advanced kidney failure.

Dialyzer: A specialized filter used in hemodialysis to remove waste products and excess fluids from the blood.

End-Stage Renal Disease (ESRD): A medical condition characterized by the irreversible loss of kidney function, requiring dialysis or kidney transplantation for survival.

Evaluation and Management (E/M) Service: A service provided by healthcare professionals to assess and manage a patient’s health status, which may include examinations, consultations, and treatment planning.

7. Clinical Examples

1. A patient with ESRD arrives for their scheduled hemodialysis session, and the provider assesses their vital signs and reviews their lab results before starting treatment.

2. During a hemodialysis session, a patient experiences cramping, prompting the provider to adjust the dialysis parameters to alleviate discomfort.

3. A patient undergoing outpatient hemodialysis receives education on dietary restrictions and fluid intake to manage their condition effectively.

4. After a hemodialysis session, the provider monitors the patient’s access site for any signs of bleeding or infection.

5. A patient with multiple comorbidities requires a coordinated care approach, involving collaboration between the nephrologist and other specialists during their hemodialysis treatment.

6. A provider conducts a pre-procedure evaluation for a new patient starting hemodialysis, including a review of their medical history and current medications.

7. Following a hemodialysis session, the provider discusses the patient’s lab results and makes adjustments to their treatment plan based on their response to the procedure.

8. A patient with non-ESRD kidney dysfunction receives hemodialysis as part of their treatment plan, with the provider monitoring their progress closely.

9. During a routine hemodialysis session, the provider identifies an issue with the dialyzer and promptly replaces it to ensure the patient’s safety.

10. A patient expresses concerns about their hemodialysis treatment, and the provider takes the time to address their questions and provide reassurance.