How To Use CPT Code 90965

CPT 90965 describes the services provided for end-stage renal disease (ESRD) patients aged 12-19 who are receiving home dialysis. 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 90965?

CPT 90965 can be used to describe the comprehensive management of end-stage renal disease (ESRD) related services for patients aged 12-19 who are receiving home dialysis. This code encompasses the evaluation and management of the patient’s ESRD care, including nutrition assessment, growth and development monitoring, and counseling of parents.

2. Official Description

The official description of CPT code 90965 is: ‘End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 12-19 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 ESRD related physician services for a one-month period for patients aged 12-19 who are receiving home dialysis.
2. This includes evaluating and managing the patient’s ESRD care, establishing and revising the home dialysis schedule and prescription, monitoring growth and development, assessing nutrition requirements, and providing counseling to parents.
3. The provider also engages in telephone and electronic communications regarding the patient, coordinates care, offers regular counseling and support to parents and caregivers, and plans for the patient’s transition to adult care.

4. Qualifying circumstances

CPT 90965 is applicable to patients aged 12-19 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. The care is managed by a healthcare provider who may be a physician, clinical nurse specialist, nurse practitioner, or physician’s assistant.

5. When to use CPT code 90965

CPT code 90965 should be used when a patient aged 12-19 with end-stage renal disease (ESRD) is receiving home dialysis and requires comprehensive management of their care. This code covers the evaluation and management of ESRD-related services, including nutrition monitoring, growth and development assessment, and counseling of parents.

6. Documentation requirements

To support a claim for CPT 90965, 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 nutrition adequacy monitoring
• Assessment of growth and development
• Counseling provided to parents
• Communication and coordination of care
• Progress and plans for transition to adult care
• Signature of the healthcare provider managing the ESRD-related services

7. Billing guidelines

When billing for CPT 90965, ensure that the patient is aged 12-19 and receiving home dialysis for end-stage renal disease (ESRD). The services provided should include monitoring nutrition adequacy, assessing growth and development, and counseling parents. It is important to follow Medicare guidelines for monthly capitation payment and face-to-face patient visits. CPT code 90965 should not be reported with other codes for ESRD-related services within the same month.

8. Historical information

CPT 90965 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 17-year-old patient receiving home dialysis, including nutrition monitoring, growth and development assessment, and counseling of parents.
2. A nurse practitioner evaluating and managing the ESRD care of a 14-year-old patient on home dialysis, monitoring nutrition adequacy, assessing growth and development, and providing counseling to parents.
3. A clinical nurse specialist coordinating the care of a 16-year-old patient with ESRD receiving home dialysis, conducting regular counseling and support for parents, and planning for the patient’s transition to adult care.
4. A physician’s assistant establishing and revising the home dialysis schedule and prescription for a 19-year-old patient with ESRD, monitoring growth and development, and providing ongoing counseling to parents.
5. A nurse practitioner assessing nutrition requirements and providing counseling to parents of a 15-year-old patient with ESRD receiving home dialysis, coordinating care, and planning for future transition to adult care.