How To Use CPT Code 90958

CPT 90958 describes the monthly services provided to patients between the ages of 12 and 19 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 90958?

CPT 90958 can be used to describe the monthly services provided to patients between the ages of 12 and 19 with end-stage renal disease (ESRD). These services include monitoring the adequacy of nutrition, assessing growth and development, and counseling parents. The provider sees the patient face-to-face two to three times per month to provide this care.

2. Official Description

The official description of CPT code 90958 is: ‘End-stage renal disease (ESRD) related services monthly, for patients 12-19 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 12 and 19 years old.
2. The provider sees the patient face-to-face during dialysis sessions two to three 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, monitoring of pubertal development and school progress, telephone and electronic communications regarding the patient, care coordination, counseling and support of parents or caregivers, and planning and monitoring of progress for future transition to adult care.

4. Qualifying circumstances

Patients eligible to receive CPT 90958 services are those between the ages of 12 and 19 with end-stage renal disease (ESRD). The provider must see the patient face-to-face two to three times per month during dialysis sessions. The services included in this code cover a range of care, including examinations, dialysis management, laboratory test review, medication and supplement needs, growth and developmental monitoring, nutrition assessment, pubertal development monitoring, school progress monitoring, communication with the patient, care coordination, counseling and support of parents or caregivers, and planning for future transition to adult care.

5. When to use CPT code 90958

CPT code 90958 should be used when providing monthly services to patients between the ages of 12 and 19 with end-stage renal disease (ESRD). The provider must see the patient face-to-face two to three times per month during dialysis sessions to provide the necessary care. This code should not be used for dialysis treatment itself, as separate codes exist for that purpose.

6. Documentation requirements

To support a claim for CPT 90958, the provider must document the following information:

• Patient’s age and diagnosis of end-stage renal disease (ESRD)
• Date, start and end time of each face-to-face visit during the month
• Details of the services provided during each visit, including examinations, dialysis management, laboratory test review, medication and supplement needs, growth and developmental monitoring, nutrition assessment, pubertal development monitoring, school progress monitoring, communication with the patient, care coordination, counseling and support of parents or caregivers, and planning for future transition to adult care
• Signature of the provider providing the service

7. Billing guidelines

When billing for CPT 90958, ensure that the provider sees the patient face-to-face two to three times per month during dialysis sessions. This code should not be reported with dialysis treatment codes. It is important to note that Medicare considers a month as referring to a calendar month for payment of ESRD-related services under the Monthly Capitation Payment. Additional tips for reporting CPT 90958 may include considering the location of the service and using appropriate modifiers if necessary.

8. Historical information

CPT 90958 was added to the Current Procedural Terminology system on January 1, 2009. There was a code change on January 1, 2013, which modified the description of the services provided.

9. Examples

1. A physician providing monthly services to a 15-year-old patient with end-stage renal disease, including monitoring nutrition, assessing growth and development, and counseling parents.
2. A nurse practitioner seeing a 17-year-old patient with end-stage renal disease two to three times per month during dialysis sessions to provide comprehensive care.
3. A physician assistant managing the monthly care of a 19-year-old patient with end-stage renal disease, including overseeing dialysis visits, reviewing laboratory tests, and counseling parents.
4. A nephrologist providing face-to-face visits two to three times per month to a 14-year-old patient with end-stage renal disease, monitoring growth and development, and coordinating care with other healthcare professionals.