How To Use CPT Code 90970

CPT 90970 describes the management of end-stage renal disease (ESRD) related services for dialysis patients who receive 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 90970?

CPT 90970 can be used to describe the management of daily outpatient ESRD related services for dialysis patients who receive less than a full month of service per day. This code is reported per day and is applicable to patients who are 20 years of age or older and have been diagnosed with end-stage renal disease.

2. Official Description

The official description of CPT code 90970 is: ‘End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 20 years of age and older.’

3. Procedure

1. The healthcare provider manages all the daily outpatient ESRD related services for a dialysis patient who receives less than a full month of service per day.
2. This code is used 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, or a patient who has one or more face-to-face visits without a complete assessment and experiences hospitalization, dialysis cessation due to death, or undergoes a transplant.
3. The provider reports CPT 90970 per day for each calendar month in which the patient receives less than a full month of dialysis services.

4. Qualifying circumstances

CPT 90970 is applicable to patients who are 20 years of age or older and have been diagnosed with end-stage renal disease. It is used when the patient receives less than a full month of dialysis services per day. This code may be reported for various circumstances, including partial month dialysis for home dialysis patients, patients receiving services for less than a month while traveling, patients who have face-to-face visits without a complete assessment and experience hospitalization, dialysis cessation due to death, or undergo a transplant, and patients who permanently change their provider during the month.

5. When to use CPT code 90970

CPT code 90970 should be used when a dialysis patient who is 20 years of age or older receives less than a full month of dialysis services per day. It is important to report this code per day for each calendar month in which the patient meets the qualifying circumstances.

6. Documentation requirements

To support a claim for CPT 90970, the healthcare provider must document the following information:

• Confirmation of the patient’s diagnosis of end-stage renal disease
• Documentation of the patient’s age (must be 20 years or older)
• Record of the number of days the patient received dialysis services for less than a full month
• Explanation of the qualifying circumstances that justify the use of CPT 90970
• Signature of the healthcare provider managing the ESRD related services

7. Billing guidelines

When billing for CPT 90970, ensure that the patient meets the qualifying circumstances, including being 20 years of age or older and receiving less than a full month of dialysis services per day. It is important to report this code per day for each calendar month in which the patient meets the criteria. Additionally, consider the guidelines for reporting CPT 90970 in conjunction with other codes, if applicable. It is important to follow Medicare’s monthly capitation payment rules for ESRD-related services.

8. Historical information

CPT 90970 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 patient receives dialysis services for 15 days in a calendar month due to hospitalization for a kidney transplant.
2. A home dialysis patient receives dialysis services for 20 days in a calendar month due to a temporary interruption in their treatment schedule.
3. A patient travels away from home and receives dialysis services for 10 days in a calendar month.
4. A dialysis patient permanently changes their provider during the month and receives dialysis services for 25 days in a calendar month.
5. A patient has face-to-face visits without a complete assessment and experiences dialysis cessation due to death, receiving dialysis services for 5 days in a calendar month.