How To Use CPT Code 90969

CPT 90969 describes the management of end-stage renal disease (ESRD) related services for dialysis for patients aged 12-19 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 90969?

CPT 90969 is used to describe the management of end-stage renal disease (ESRD) related services for dialysis for patients aged 12-19 years. This code is used when a healthcare provider manages the daily outpatient ESRD related services for a dialysis patient who receives less than one full month of dialysis care.

2. Official Description

The official description of CPT code 90969 is: ‘End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 12-19 years of age.’

3. Procedure

1. The healthcare provider manages all the daily outpatient ESRD related services for a dialysis patient aged 12-19 years who receives less than one full month of dialysis care.
2. This code is reported per day and can be used in various situations, such as when a patient receives a partial month of dialysis, when a patient is traveling away from home and receives services for less than a month, or when a patient has one or more face-to-face visits without a complete assessment and experiences changes in their dialysis care during the month.

4. Qualifying circumstances

Patients eligible to receive CPT 90969 services are those aged 12-19 years who have end-stage renal disease (ESRD) and require dialysis. The healthcare provider must manage the daily outpatient ESRD related services for the patient for less than one full month. This code is used in situations where the patient receives a partial month of dialysis, is traveling away from home and receives services for less than a month, or experiences changes in their dialysis care during the month.

5. When to use CPT code 90969

CPT code 90969 should be used when a healthcare provider manages the daily outpatient ESRD related services for a dialysis patient aged 12-19 years who receives less than one full month of dialysis care. This code is reported per day and should be used in the qualifying circumstances mentioned above.

6. Documentation requirements

To support a claim for CPT 90969, the healthcare provider must document the following information:

• Patient’s age (12-19 years)
• Diagnosis of end-stage renal disease (ESRD)
• Duration of dialysis care provided (less than one full month)
• Date(s) of service
• Details of the daily outpatient ESRD related services managed
• Any changes in the patient’s dialysis care during the month
• Signature of the healthcare provider managing the services

7. Billing guidelines

When billing for CPT 90969, ensure that the patient is aged 12-19 years and has end-stage renal disease (ESRD) requiring dialysis. This code should be reported per day for the management of ESRD related services for less than one full month. It is important to follow Medicare guidelines for payment of ESRD-related services under the Monthly Capitation Payment. Consider the calendar month and report the code accordingly.

8. Historical information

CPT 90969 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 16-year-old patient with end-stage renal disease (ESRD) receives dialysis services for 15 days in a month. The healthcare provider manages the daily outpatient ESRD related services for the patient during this period.
2. A 14-year-old patient with end-stage renal disease (ESRD) receives dialysis services for 10 days in a month. The healthcare provider manages the daily outpatient ESRD related services for the patient during this period.
3. A 17-year-old patient with end-stage renal disease (ESRD) receives dialysis services for 20 days in a month. The healthcare provider manages the daily outpatient ESRD related services for the patient during this period.
4. A 13-year-old patient with end-stage renal disease (ESRD) receives dialysis services for 25 days in a month. The healthcare provider manages the daily outpatient ESRD related services for the patient during this period.
5. An 18-year-old patient with end-stage renal disease (ESRD) receives dialysis services for 5 days in a month. The healthcare provider manages the daily outpatient ESRD related services for the patient during this period.