How To Use CPT Code 90955

CPT 90955 describes the monthly services provided to patients between the ages of 2 and 11 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 90955?

CPT 90955 can be used to describe the monthly services provided to patients between the ages of 2 and 11 with end-stage renal disease (ESRD). These services include monitoring the adequacy of nutrition, assessing growth and development, and counseling parents. The provider must have 2-3 face-to-face visits with the patient per month to provide this care.

2. Official Description

The official description of CPT code 90955 is: ‘End-stage renal disease (ESRD) related services monthly, for patients 2-11 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 provider manages all outpatient ESRD related services for a one-month period for patients between the ages of 2 and 11 years old.
2. The provider sees the patient face-to-face during dialysis sessions 2-3 times during the 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, medication and supplement needs, monitoring of growth and developmental progress, ongoing assessment of nutrition requirements, school progress monitoring, telephone and electronic communications regarding the patient, and care coordination and counseling of parents and caregivers.

4. Qualifying circumstances

Patients eligible to receive CPT 90955 services are those between the ages of 2 and 11 with end-stage renal disease (ESRD). The provider must have 2-3 face-to-face visits with the patient per month to provide the necessary care. The services included in this code involve monitoring nutrition adequacy, assessing growth and development, and counseling parents.

5. When to use CPT code 90955

CPT code 90955 should be used when providing monthly services to patients between the ages of 2 and 11 with end-stage renal disease (ESRD). The provider must have 2-3 face-to-face visits with the patient per month to provide the necessary care. This code should not be used for dialysis treatment, which has separate codes for reporting.

6. Documentation requirements

To support a claim for CPT 90955, the provider 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 during the month
• Details of the services provided, including monitoring of nutrition, assessment of growth and development, and counseling of parents
• Review of laboratory tests, medications, and supplement needs
• Progress and interventions made during the month
• Communication with the patient and parents/caregivers
• Care coordination and counseling provided

7. Billing guidelines

When billing for CPT 90955, ensure that the provider has 2-3 face-to-face visits with the patient per month. This code should not be reported with dialysis treatment codes. It is important to accurately document the services provided and meet the requirements outlined in the documentation requirements section.

8. Historical information

CPT 90955 was added to the Current Procedural Terminology system on January 1, 2009. There have been no updates to the code since its addition.

9. Examples

1. A physician providing monthly services to a 6-year-old patient with end-stage renal disease, including monitoring nutrition, assessing growth and development, and counseling parents.
2. A nurse practitioner having 2-3 face-to-face visits per month with a 9-year-old patient with end-stage renal disease, monitoring nutrition, assessing growth and development, and counseling parents.
3. A physician assistant seeing a 4-year-old patient with end-stage renal disease 2-3 times per month, monitoring nutrition, assessing growth and development, and counseling parents.
4. A nephrologist providing monthly services to an 11-year-old patient with end-stage renal disease, including monitoring nutrition, assessing growth and development, and counseling parents.
5. A pediatrician having 2-3 face-to-face visits per month with a 7-year-old patient with end-stage renal disease, monitoring nutrition, assessing growth and development, and counseling parents.