How To Use CPT Code 90964

CPT 90964 describes the services provided for end-stage renal disease (ESRD) related to home dialysis for patients aged 2-11 years. 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 90964?

CPT 90964 can be used to describe the comprehensive management of end-stage renal disease (ESRD) related to home dialysis for patients aged 2-11 years. This code encompasses the evaluation and management of all aspects of the patient’s ESRD care, including nutrition assessment, growth and development monitoring, and counseling of parents or caregivers.

2. Official Description

The official description of CPT code 90964 is: ‘End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents.’

3. Procedure

1. The healthcare provider manages all aspects of ESRD-related care for a patient aged 2-11 years who is receiving home dialysis.
2. This includes establishing and revising the patient’s home dialysis schedule and prescription, monitoring growth and development, assessing nutrition requirements, and intervening as necessary.
3. The provider also addresses behavioral and school problems, provides counseling to parents or caregivers, and coordinates care.
4. Regular counseling and support are provided to parents or caregivers to ensure the patient’s well-being and adherence to the prescribed treatment plan.

4. Qualifying circumstances

CPT 90964 is applicable to patients aged 2-11 years who have end-stage renal disease (ESRD) and are receiving home dialysis. The services provided under this code include monitoring nutrition adequacy, assessing growth and development, and counseling parents or caregivers. The healthcare provider must be a physician, clinical nurse specialist, nurse practitioner, or physician’s assistant.

5. When to use CPT code 90964

CPT code 90964 should be used when managing the comprehensive care of a patient aged 2-11 years with end-stage renal disease (ESRD) who is receiving home dialysis. It is important to ensure that the patient meets the age criteria and is receiving home dialysis. This code should not be used for patients outside the specified age range or for patients receiving other forms of dialysis.

6. Documentation requirements

To support a claim for CPT 90964, the healthcare 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
• Documentation of growth and developmental progress
• Assessment of nutrition adequacy and any necessary interventions
• Counseling provided to parents or caregivers
• Coordination of care and any additional support provided

7. Billing guidelines

When billing for CPT 90964, ensure that the patient meets the age criteria and is receiving home dialysis. The services provided under this code should encompass all aspects of ESRD-related care for a full month. It is important to note that a face-to-face patient visit must be conducted at least once per month for the monthly capitation payment of home dialysis covered services. The provider may request a waiver of this requirement on a case-by-case basis.

8. Historical information

CPT 90964 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 aspects of ESRD-related care for a 6-year-old patient receiving home dialysis, including nutrition monitoring, growth and development assessment, and counseling of parents.
2. A nurse practitioner coordinating the care of a 10-year-old patient with ESRD who is on home dialysis, providing regular counseling and support to the parents and addressing any behavioral or school problems.
3. A clinical nurse specialist conducting a face-to-face visit with an 8-year-old patient receiving home dialysis, assessing nutrition adequacy, and making necessary adjustments to the treatment plan.
4. A physician’s assistant establishing a home dialysis schedule and prescription for a 5-year-old patient with ESRD, monitoring growth and development, and providing ongoing management and support to the parents.
5. A physician conducting regular counseling sessions with the parents of a 9-year-old patient with ESRD who is on home dialysis, addressing any concerns or questions and ensuring adherence to the prescribed treatment plan.