How To Use CPT Code 90953

CPT 90953 describes the monthly end-stage renal disease (ESRD) related services provided to patients younger than 2 years of age. 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 90953?

CPT 90953 can be used to describe the monthly management of end-stage renal disease (ESRD) related services for patients who are younger than 2 years old. This code is used when a physician or other qualified healthcare professional provides comprehensive care for the patient, including monitoring nutrition adequacy, assessing growth and development, and counseling parents. The provider must have a face-to-face visit with the patient once a month to provide this care.

2. Official Description

The official description of CPT code 90953 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 1 face-to-face visit by a physician or other qualified health care professional per month.’

3. Procedure

1. The provider manages all outpatient ESRD related services for a one-month period for a patient younger than 2 years old.
2. The provider sees the patient face-to-face during dialysis sessions once a month.
3. The care bundled into this code includes scheduled and episodic examinations for disease management, establishment and changes to the patient’s dialysis schedule and prescription, oversight of each dialysis visit, review of laboratory tests, medications, and supplement needs, monitoring of growth and developmental progress, assessment of feeding and nutrition requirements, and adjustments as necessary.
4. The provider also engages in telephone and electronic communications regarding the patient, care coordination, and regular counseling and support of the parents and/or caregivers and siblings.

4. Qualifying circumstances

Patients eligible to receive CPT 90953 services are those who are younger than 2 years old and have end-stage renal disease (ESRD). The provider must have a face-to-face visit with the patient once a month to provide comprehensive care, including monitoring nutrition adequacy, assessing growth and development, and counseling parents. The term ESRD refers to the final stage of kidney failure where a patient is not able to live without dialysis or a transplant due to the complete or nearly complete irreversible loss of renal function.

5. When to use CPT code 90953

CPT code 90953 should be used when a patient who is younger than 2 years old requires monthly end-stage renal disease (ESRD) related services. The provider must have a face-to-face visit with the patient once a month to provide comprehensive care, including monitoring nutrition adequacy, assessing growth and development, and counseling parents. This code should not be used for patients older than 2 years old or for patients who do not have end-stage renal disease.

6. Documentation requirements

To support a claim for CPT 90953, the provider must document the following information:

• Patient’s age and diagnosis of end-stage renal disease (ESRD)
• Date of the face-to-face visit
• Details of the services provided, including monitoring of nutrition adequacy, assessment of growth and development, and counseling of parents
• Review of laboratory tests, medications, and supplement needs
• Progress made by the patient and any adjustments to the dialysis schedule or prescription
• Documentation of telephone and electronic communications regarding the patient
• Care coordination and counseling/support provided to parents and/or caregivers and siblings

7. Billing guidelines

When billing for CPT 90953, ensure that the provider has a face-to-face visit with the patient once a month to provide the necessary care. This code should not be reported with other codes for dialysis treatment. Medicare considers a month as referring to a calendar month for payment of ESRD-related services under the Monthly Capitation Payment. The first month the patient starts dialysis treatments is the date the dialysis treatments begin through the end of that calendar month. Thereafter, each month refers to a calendar month.

8. Historical information

CPT 90953 was added to the Current Procedural Terminology system on January 1, 2009. On January 1, 2013, the code description was revised to include counseling of parents and changed to specify a face-to-face visit by a physician or other qualified healthcare professional per month.

9. Examples

1. A physician providing monthly end-stage renal disease (ESRD) related services for a patient younger than 2 years old, including monitoring nutrition adequacy, assessing growth and development, and counseling parents.
2. A qualified healthcare professional seeing a patient during dialysis sessions once a month to provide comprehensive care for end-stage renal disease (ESRD) related services.
3. A provider reviewing laboratory tests, medications, and supplement needs during a face-to-face visit with a patient younger than 2 years old who has end-stage renal disease (ESRD).
4. A physician engaging in telephone and electronic communications regarding a patient’s end-stage renal disease (ESRD) and providing counseling and support to parents and/or caregivers and siblings.