How To Use CPT Code 90968

CPT 90968 describes the management of end-stage renal disease (ESRD) related services for dialysis for patients aged 2-11 years for less than a full month of service, per day. 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 90968?

CPT 90968 can be used to describe the management of end-stage renal disease (ESRD) related services for dialysis for patients aged 2-11 years for less than a full month of service, per day. This code is used when a healthcare provider manages all the daily outpatient ESRD related services for a dialysis patient aged 2-11 years who receives dialysis services for less than one full month.

2. Official Description

The official description of CPT code 90968 is: ‘End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 2-11 years of age.’

3. Procedure

1. The healthcare provider manages all the daily outpatient ESRD related services for a dialysis patient aged 2-11 years who receives dialysis services for less than one full month.
2. This code is reported per day in situations such as a home dialysis patient who receives a partial month of dialysis, a transient patient or patient traveling away from home who receives services for less than a month, a patient who has one or more face-to-face visits without a complete assessment and the patient is either hospitalized before the assessment is done, dialysis stops due to death, or the patient has a transplant, or when the patient permanently changes their provider during the month.

4. Qualifying circumstances

Patients eligible to receive CPT 90968 services are those aged 2-11 years who have end-stage renal disease (ESRD) and require dialysis services for less than a full month. The healthcare provider must manage all the daily outpatient ESRD related services for the patient during this period. This code is specifically for patients in the specified age range and with the specified condition.

5. When to use CPT code 90968

CPT code 90968 should be used when a healthcare provider manages all the daily outpatient ESRD related services for a dialysis patient aged 2-11 years who receives dialysis services for less than a full month. This code should be reported per day for each day of service provided to the patient.

6. Documentation requirements

To support a claim for CPT 90968, the healthcare provider must document the following information:

• Patient’s age and diagnosis of end-stage renal disease (ESRD)
• Duration of dialysis services provided (less than a full month)
• Date(s) of service
• Details of the daily outpatient ESRD related services managed by the provider
• Any specific circumstances or reasons for the patient receiving less than a full month of dialysis services
• Signature of the healthcare provider managing the services

7. Billing guidelines

When billing for CPT 90968, ensure that the healthcare provider is managing all the daily outpatient ESRD related services for a dialysis patient aged 2-11 years who receives dialysis services for less than a full month. This code should be reported per day for each day of service provided to the patient. There are no specific guidelines regarding reporting this code with other codes.

8. Historical information

CPT 90968 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 healthcare provider managing all the daily outpatient ESRD related services for a 10-year-old dialysis patient for 15 days in a month.
2. A healthcare provider managing all the daily outpatient ESRD related services for an 8-year-old dialysis patient for 10 days in a month.
3. A healthcare provider managing all the daily outpatient ESRD related services for an 11-year-old dialysis patient for 25 days in a month.
4. A healthcare provider managing all the daily outpatient ESRD related services for a 5-year-old dialysis patient for 20 days in a month.
5. A healthcare provider managing all the daily outpatient ESRD related services for a 9-year-old dialysis patient for 5 days in a month.
6. A healthcare provider managing all the daily outpatient ESRD related services for a 7-year-old dialysis patient for 28 days in a month.
7. A healthcare provider managing all the daily outpatient ESRD related services for a 6-year-old dialysis patient for 12 days in a month.
8. A healthcare provider managing all the daily outpatient ESRD related services for a 4-year-old dialysis patient for 18 days in a month.
9. A healthcare provider managing all the daily outpatient ESRD related services for a 3-year-old dialysis patient for 22 days in a month.
10. A healthcare provider managing all the daily outpatient ESRD related services for an 11-year-old dialysis patient for 30 days in a month.