How To Use CPT Code 90947

CPT 90947 describes the procedure for dialysis other than hemodialysis, such as peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90947?

CPT 90947 can be used to describe dialysis procedures other than hemodialysis, such as peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies. This code is used when the procedure requires repeated evaluations by a physician or other qualified healthcare professional, with or without substantial revision of the dialysis prescription.

2. Official Description

The official description of CPT code 90947 is: ‘Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies) requiring repeated evaluations by a physician or other qualified health care professional, with or without substantial revision of dialysis prescription.’

3. Procedure

1. The physician or qualified healthcare professional assesses the patient’s condition and determines the need for dialysis other than hemodialysis.
2. The specific dialysis procedure is selected based on the patient’s condition and circumstances, such as peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies.
3. The physician or qualified healthcare professional performs the dialysis procedure, which may involve repeated evaluations and adjustments to the dialysis prescription.
4. The procedure may require the use of a dialyzer or “hemofilter” to remove fluid, electrolytes, and other substances from the blood.
5. In the case of peritoneal dialysis, the inner lining of the abdominal cavity is used as a filter to clean the blood. A dialysate containing glucose is introduced to the abdomen, and the fluid remains inside for a certain period before being drained and replaced with fresh fluid.
6. In the case of hemofiltration, the blood is pumped through a dialyzer or “hemofilter” without the use of dialysate. A pressure gradient is applied to remove water and dissolved substances from the blood.
7. Other continuous renal replacement therapies, such as continuous venovenous hemofiltration (CVVH), continuous venovenous hemodialysis (CVVHD), and continuous venovenous hemodiafiltration (CVVHDF), may be used to dialyze patients in a more physiologic way over 24 hours.

4. Qualifying circumstances

Patients eligible for CPT 90947 are those who require dialysis procedures other than hemodialysis, such as peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies. The procedure must require repeated evaluations by a physician or other qualified healthcare professional, with or without substantial revision of the dialysis prescription.

5. When to use CPT code 90947

CPT code 90947 should be used when the dialysis procedure requires repeated evaluations by a physician or other qualified healthcare professional, with or without substantial revision of the dialysis prescription. It should not be used for hemodialysis procedures.

6. Documentation requirements

To support a claim for CPT 90947, the physician or qualified healthcare professional must document the following information:

• Patient’s diagnosis and the need for dialysis other than hemodialysis
• Specific dialysis procedure performed, such as peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies
• Date and duration of the procedure
• Evaluations and adjustments made to the dialysis prescription, if applicable
• Progress made by the patient and any changes to the treatment plan
• Signature of the physician or qualified healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 90947, ensure that the procedure requires repeated evaluations by a physician or other qualified healthcare professional. It should not be reported with hemodialysis procedures. Modifier 25 should be used for separately identifiable E/M services not related to the dialysis procedure. Review the section notes in the CPT manual for specific guidelines on using these codes.

8. Historical information

CPT 90947 was added to the Current Procedural Terminology system on January 1, 1990. There have been several code changes since its addition, with the most recent change occurring on January 1, 2014.

9. Examples

1. A physician performing and evaluating peritoneal dialysis for a patient with end-stage renal disease.
2. A qualified healthcare professional performing and evaluating hemofiltration for a patient with acute kidney injury.
3. A physician performing and evaluating continuous venovenous hemodiafiltration (CVVHDF) for a critically ill patient in the ICU.
4. A qualified healthcare professional performing and evaluating peritoneal dialysis for a patient with chronic kidney disease.
5. A physician performing and evaluating other continuous renal replacement therapies for a patient with fluid overload.
6. A qualified healthcare professional performing and evaluating hemofiltration for a patient with sepsis.
7. A physician performing and evaluating peritoneal dialysis for a patient with diabetic nephropathy.
8. A qualified healthcare professional performing and evaluating continuous venovenous hemodialysis (CVVHD) for a patient with drug overdose.
9. A physician performing and evaluating other continuous renal replacement therapies for a patient with multiple organ failure.
10. A qualified healthcare professional performing and evaluating peritoneal dialysis for a patient with polycystic kidney disease.