How To Use CPT Code 90963

CPT 90963 describes the services provided for end-stage renal disease (ESRD) related to home dialysis for patients younger than 2 years old. 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 90963?

CPT 90963 can be used to describe the services provided for end-stage renal disease (ESRD) related to home dialysis for patients who are younger than 2 years old. This code encompasses the management of all ESRD-related provider services for a one-month period, including the evaluation and management of the patient’s ESRD care, establishment and revision of the home dialysis schedule and prescription, monitoring of growth and developmental progress, assessment of feeding and nutrition requirements, care coordination, and counseling and support for parents and caregivers.

2. Official Description

The official description of CPT code 90963 is: ‘End-stage renal disease (ESRD) related services for home dialysis per full month, 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.’

3. Procedure

1. The provider manages all ESRD-related services for a one-month period for a patient younger than 2 years old receiving home dialysis care.
2. This includes evaluating and managing the patient’s ESRD care, establishing and revising the home dialysis schedule and prescription, monitoring growth and developmental progress, assessing feeding and nutrition requirements, coordinating care, and providing counseling and support to parents and caregivers.

4. Qualifying circumstances

CPT 90963 is used for patients who are younger than 2 years old and have end-stage renal disease (ESRD) requiring home dialysis care. The services provided include monitoring for nutrition adequacy, assessment of growth and development, and counseling of parents. The patient must be receiving home dialysis care and must meet the age criteria specified in the code description.

5. When to use CPT code 90963

CPT code 90963 should be used when providing end-stage renal disease (ESRD) related services for home dialysis to patients who are younger than 2 years old. This code covers the management of all ESRD-related provider services for a one-month period, including monitoring nutrition adequacy, assessing growth and development, and counseling parents. It is important to ensure that the patient meets the age criteria specified in the code description.

6. Documentation requirements

To support a claim for CPT 90963, the provider must document the following information:

• Patient’s age and diagnosis of end-stage renal disease (ESRD)
• Details of the home dialysis schedule and prescription
• Monitoring of nutrition adequacy
• Assessment of growth and development
• Counseling and support provided to parents
• Any revisions to the home dialysis schedule or prescription
• Communication with the patient and/or caregivers
• Coordination of care

7. Billing guidelines

When billing for CPT 90963, ensure that the patient meets the age criteria specified in the code description. This code covers the management of all ESRD-related provider services for a one-month period. It is important to document all the necessary information and meet the documentation requirements. Additionally, consider any specific billing guidelines provided by the payer or Medicare for reporting this code.

8. Historical information

CPT 90963 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 managing all ESRD-related services for a one-month period for a patient younger than 2 years old receiving home dialysis care, including monitoring nutrition adequacy, assessing growth and development, and counseling parents.
2. A clinical nurse specialist coordinating the care and providing counseling and support to parents of a patient younger than 2 years old with ESRD receiving home dialysis care.
3. A nurse practitioner evaluating and managing the ESRD care of a patient younger than 2 years old, establishing and revising the home dialysis schedule and prescription, and monitoring growth and developmental progress.
4. A physician’s assistant assessing feeding and nutrition requirements, coordinating care, and providing counseling to parents of a patient younger than 2 years old with ESRD receiving home dialysis care.
5. A physician conducting a face-to-face visit with a patient younger than 2 years old receiving home dialysis care, evaluating the patient’s ESRD care, and providing counseling and support to parents.
6. A clinical nurse specialist monitoring nutrition adequacy, assessing growth and development, and coordinating care for a patient younger than 2 years old with ESRD receiving home dialysis care.
7. A nurse practitioner revising the home dialysis schedule and prescription, assessing feeding and nutrition requirements, and providing counseling and support to parents of a patient younger than 2 years old with ESRD receiving home dialysis care.
8. A physician’s assistant evaluating and managing the ESRD care of a patient younger than 2 years old, monitoring growth and developmental progress, and coordinating care.
9. A physician conducting a face-to-face visit with a patient younger than 2 years old receiving home dialysis care, establishing the home dialysis schedule and prescription, and providing counseling and support to parents.