How To Use CPT Code 90959

CPT 90959 describes the monthly end-stage renal disease (ESRD) related services provided to patients between the ages of 12 and 19. 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 90959?

CPT 90959 can be used to describe the monthly management of end-stage renal disease (ESRD) related services for patients between the ages of 12 and 19. This code is used when a physician or other qualified healthcare professional has a face-to-face visit with the patient once a month to provide comprehensive care.

2. Official Description

The official description of CPT code 90959 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 1 face-to-face visit by a physician or other qualified health care professional per month.’

3. Procedure

1. The healthcare professional manages all outpatient ESRD related services for a one-month period for patients between the ages of 12 and 19.
2. During this period, the healthcare professional has a face-to-face visit with the patient once to provide comprehensive care.
3. The care bundled into this code includes scheduled and episodic examinations, 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, 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 for future transition to adult care.

4. Qualifying circumstances

Patients eligible to receive CPT 90959 services are those between the ages of 12 and 19 who have end-stage renal disease (ESRD). The healthcare professional providing the services must have a face-to-face visit with the patient once a month to monitor nutrition adequacy, assess growth and development, and provide counseling to parents. This code is specific to patients within this age range and with this condition.

5. When to use CPT code 90959

CPT code 90959 should be used when a physician or other qualified healthcare professional has a face-to-face visit with a patient between the ages of 12 and 19 who has end-stage renal disease (ESRD). This code is appropriate for monthly management of ESRD-related services, including monitoring nutrition adequacy, assessing growth and development, and counseling parents. It should be reported once per month for each patient.

6. Documentation requirements

To support a claim for CPT 90959, the healthcare professional 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
• Any changes to the patient’s dialysis schedule or prescription
• Review of laboratory tests, medications, and supplement needs
• Monitoring of growth, developmental progress, pubertal development, and school progress
• Telephone and electronic communications regarding the patient
• Care coordination and counseling/support of parents or caregivers
• Planning and monitoring of progress for future transition to adult care
• Signature of the physician or qualified healthcare professional providing the service

7. Billing guidelines

When billing for CPT 90959, ensure that the healthcare professional providing the service has a face-to-face visit with the patient once a month. This code should not be reported with dialysis treatment codes (90935-90937). It is important to consider the specific guidelines and requirements of the payer when submitting claims for CPT 90959.

8. Historical information

CPT 90959 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 to include counseling of parents in the services provided.

9. Examples

1. A physician having a face-to-face visit with a 14-year-old patient with ESRD to monitor nutrition adequacy, assess growth and development, and counsel parents.
2. A qualified healthcare professional seeing a 17-year-old patient with ESRD for a comprehensive visit, including reviewing laboratory tests, adjusting medications, and discussing future transition to adult care.
3. A physician having a monthly face-to-face visit with a 15-year-old patient with ESRD to oversee dialysis visits, monitor pubertal development, and provide counseling and support to parents.
4. A qualified healthcare professional seeing an 18-year-old patient with ESRD to assess nutrition requirements, monitor school progress, and coordinate care with other healthcare providers.
5. A physician having a face-to-face visit with a 13-year-old patient with ESRD to establish a dialysis schedule, review medication needs, and provide ongoing counseling to parents.
6. A qualified healthcare professional seeing a 16-year-old patient with ESRD to assess growth and developmental progress, monitor supplement needs, and plan for future transition to adult care.
7. A physician having a monthly face-to-face visit with a 19-year-old patient with ESRD to monitor nutrition adequacy, review laboratory tests, and provide counseling and support to parents.