How To Use CPT Code 90952

CPT 90952 describes the monthly services provided for patients younger than 2 years old with end-stage renal disease (ESRD). This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90952?

CPT 90952 can be used to describe the monthly services provided to patients younger than 2 years old who have end-stage renal disease (ESRD). This code is used when a physician or other qualified healthcare professional has face-to-face visits with the patient 2-3 times per month to monitor nutrition adequacy, assess growth and development, and provide counseling to parents. These services are essential for managing the patient’s condition and ensuring their well-being.

2. Official Description

The official description of CPT code 90952 is: ‘End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professional per month.’

3. Procedure

1. The physician or qualified healthcare professional manages all outpatient ESRD-related services for a one-month period for a patient younger than 2 years old.
2. During this period, the provider has 2-3 face-to-face visits with the patient to monitor their nutrition adequacy, assess their growth and development, and provide counseling to parents.
3. The provider also performs scheduled and episodic examinations to manage the disease, establishes and adjusts the patient’s dialysis schedule and prescription, oversees each dialysis visit, reviews laboratory tests and medications, and monitors the patient’s growth and developmental progress.
4. Additionally, the provider assesses feeding and nutrition requirements, communicates with the patient and their parents through telephone and electronic means, and provides counseling and support to the parents and/or caregivers.

4. Qualifying circumstances

CPT 90952 is applicable to patients younger than 2 years old who have end-stage renal disease (ESRD). These patients require ongoing monitoring of nutrition adequacy, growth and development assessment, and counseling for their parents. The services must be provided by a physician or other qualified healthcare professional through 2-3 face-to-face visits per month.

5. When to use CPT code 90952

CPT code 90952 should be used when a patient younger than 2 years old has been diagnosed with end-stage renal disease (ESRD) and requires monthly services for monitoring nutrition adequacy, growth and development assessment, and counseling for parents. The code should be reported for each month in which the face-to-face visits occur.

6. Documentation requirements

To support a claim for CPT 90952, the healthcare professional must document the following information:

• Patient’s age and diagnosis of end-stage renal disease (ESRD)
• Date and duration of each face-to-face visit
• Details of the services provided during each visit, including monitoring of nutrition adequacy, growth and development assessment, and counseling for parents
• Review of laboratory tests, medications, and supplement needs
• Progress and milestones achieved by the patient
• Communication with the patient and parents through telephone and electronic means
• Care coordination and counseling provided to parents and/or caregivers
• Signature of the physician or qualified healthcare professional providing the services

7. Billing guidelines

When billing for CPT 90952, ensure that the services are provided by a physician or other qualified healthcare professional through 2-3 face-to-face visits per month. It is important to note that CPT 90952 does not include dialysis treatment, which should be reported separately. Additionally, consider the guidelines for reporting ESRD-related services under the Monthly Capitation Payment. It is crucial to follow the correct coding and billing procedures to ensure accurate reimbursement.

8. Historical information

CPT 90952 was added to the Current Procedural Terminology system on January 1, 2009. Since its addition, there have been no updates or changes to the code.

9. Examples

1. A physician has 2 face-to-face visits with a 1-year-old patient with ESRD to monitor their nutrition adequacy, assess their growth and development, and provide counseling to the parents.
2. A qualified healthcare professional sees a 6-month-old patient with ESRD for 3 face-to-face visits during the month to ensure their nutrition adequacy, assess their growth and development, and offer counseling to the parents.
3. A physician has 2 face-to-face visits with a 2-year-old patient with ESRD to monitor their nutrition adequacy, assess their growth and development, and provide counseling to the parents.
4. A qualified healthcare professional sees a 1-year-old patient with ESRD for 3 face-to-face visits during the month to ensure their nutrition adequacy, assess their growth and development, and offer counseling to the parents.