Coding Guide for Hemodialysis CPT codes

Basics about Hemodialysis and its CPT codes

Dialysis is a process to remove toxins from the blood and to maintain fluid and electrolyte balance when the kidneys no longer function. while, in peritoneal dialysis, a fluid is introduced into the peritoneal cavity that removes toxins and electrolytes, which passively leach into the fluid. Hemofiltration, similar to hemodialysis, employs passing large volumes of blood over extracorporeal, adsorbent filters that remove waste products from the blood. Different CPT codes are used for coding dialysis for non-ESRD (like CPT code 90935 and 90937) and ESRD patients ( CPT codes from 90951-90962).

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Description of Hemodialysis CPT codes 90935 and 90937

Inpatient ESRD Hemodialysis and outpatient hemodialysis performed on non-ESRD patients (that is, patients in acute renal failure requiring a brief period of dialysis prior to recovery) are reported with CPT codes 90935 and 90937. These CPT codes describe the hemodialysis procedure with all evaluation and management services related to the patient’s renal disease on the day of the hemodialysis.

A nurse or technician inserts two needles into a previously created vascular access site. The vascular access site may be a surgically created internal fistula or shunt, an internal graft, or less commonly a central venous catheter. Each needle is attached to a separate piece of flexible plastic tubing that is connected to the dialysis machine. One tube removes blood from the body. The blood is circulated through the dialysis machine and then returned to the body through the second tube. The blood circulating through the dialysis machine passes on one side of a membrane and dialysis fluid passes on the other.

The wastes and excess fluid pass from the blood through the membrane and into the dialysis fluid. These wastes are discarded with the dialysis fluid. The cleansed blood is returned to the bloodstream through the second tube. The hemodialysis procedure includes all evaluation and management services performed on the date of the dialysis procedure that are related to the patient’s renal disease. CPT code 90935 is used when a single evaluation and management service is performed on the date of the hemodialysis procedure. CPT code 90937 is used when repeated evaluation and management services are required during the course of the hemodialysis procedure.

90935 – Hemodialysis procedure with single evaluation by a physician or other qualified health care professional

90937 – Hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription

A single evaluation (90935) is reported for a standard, uncomplicated dialysis session in which the physician evaluates the patient but does not perform any other service during the dialysis session.

CPT code 90935 applies to one hemodialysis treatment that includes a single physician or other qualified health care provider’s evaluation of the patient and 90937 is for a hemodialysis procedure when patient re-evaluation(s) must be done during the procedure, with or without substantial revision of the dialysis prescription.

Repeated evaluations (90937) involve a more complicated dialysis session in which the physician may visit the patient several times during a session and may also adjust the dialysis prescription.

Other than Hemodialysis procedure CPT codes

Dialysis procedures other than dialysis as well as evaluation and management services related to the patient’s renal disease on the day of the procedure, are reported with CPT code 90945 (if only one evaluation of the patient is required related to that procedure) or CPT ode 90947 (when patient re-evaluation is required during a procedure).

A dialysis procedure other than hemodialysis with related evaluation services is performed. Types of dialysis procedures performed include peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies. Peritoneal dialysis, hemofiltration, and other continuous renal replacement therapies filter blood continuously without interruption. If peritoneal dialysis is performed, a nurse or technician instills dialysis fluid through a previously placed abdominal catheter.

The dialysis solution contains the sugar dextrose, which pulls wastes and extra fluid out of the blood through the peritoneal membrane and into the abdominal cavity. The dialysis fluid remains in the abdominal cavity for a period of four to six hours after which the dialysis solution along with the wastes and excess fluid is removed from the abdomen through the catheter. This process of filling and draining the abdomen may be repeated several times during the day.

Hemofiltration may be performed by an arteriovenous or venovenous procedure. In an arteriovenous procedure, the femoral artery is cannulated. Arterial pressure forces blood through a filter into the femoral vein. Water and soluble waste products filter from the blood through a permeable membrane and are discarded. The cleansed blood is returned to the body with replacement fluid of physiologically balanced water and electrolytes. The procedure for venovenous filtration is similar. A double lumen catheter is placed in the femoral, subclavian, or internal jugular vein.

A pump is used to push blood from the vein through the dialysis circuit. The cleansed blood is then pushed back into the same vein. CPT code 90945 is used when a single evaluation and management service is performed on the date of the peritoneal dialysis, hemofiltration, or other continuous renal replacement therapy. CPT code 90947 is used when repeated evaluation and management services are required during the course of the peritoneal dialysis procedure, hemofiltration procedure, or other continuous renal replacement therapy procedure.

90945 – Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single evaluation by a physician or other qualified health care professional

90947 – Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies) requiring repeated evaluations by a physician or other qualified health care professional, with or without substantial revision of dialysis prescription

CPT code 90945 applies to one dialysis procedure, other than hemodialysis, with a single physician or other qualified health care provider’s evaluation of the patient. CPT code 90947 applies to a dialysis procedure, other than hemodialysis, that requires repeated provider evaluations, with or without substantial revision of a dialysis prescription.

CPT codes are used to report peritoneal dialysis services may include the insertion of the catheter used to administer peritoneal dialysis. ESRD facilities report dialysis.

Dialysis procedures at an ESRD facility to acute kidney injury (AKI) patients are reported with HCPCS code G0491, dialysis procedure at a Medicare certified ESRD facility for acute kidney injury without ESRD. Code G0492, dialysis procedure with single evaluation by a physician or other qualified healthcare professional for acute kidney injury without ESRD, reports a dialysis procedure with physician evaluation.

G0491 – Dialysis procedure at a Medicare certified ESRD facility for acute kidney injury without ESRD

G0492 – Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without ESRD

CPT codes 90951-90962 are reported once per month to distinguish age-specific services related to the patient’s end-stage renal disease (ESRD) performed in an outpatient setting with three levels of service based on the number of face-to-face visits. ESRD-related services by a physician or other qualified health care professional include establishment of a dialyzing cycle, outpatient evaluation and management of the dialysis visits, telephone calls, and patient management during the dialysis provided during a full month.

In the circumstances in which the patient has had a complete assessment visit during the month and services are provided over a period of less than a month, 90951-90962 may be used according to the number of visits performed.

Codes 90935-90937 are only reported for inpatient hemodialysis and non-ESRD services. Codes 90963-90966 are reported once per month for a full month of ESRD services for home dialysis patients. For less than a full month of service use code 90967-90970 to report ESRD services per day (such as when services are provided to transient patients.)