2025 CPT code 90937
(Active) Effective Date: N/A Revision Date: N/A Medicine - Hemodialysis Procedures Medicine Services and Procedures > Dialysis Services and Procedures Feed
Hemodialysis procedure requiring repeated evaluations, with or without substantial dialysis prescription revision.
Modifier 25 may be appended to other E/M codes if separate and distinct E/M services were performed on the same day as the hemodialysis, unrelated to the dialysis.
Multiple evaluations during hemodialysis are medically necessary when the patient's condition requires ongoing monitoring and potential intervention to manage complications or ensure patient safety.Documentation must support the clinical rationale for these repeated assessments.Any adjustments to the dialysis plan based on these evaluations must be clearly documented.
The clinical responsibility lies with the physician or qualified healthcare professional performing the hemodialysis and providing the necessary evaluations during the procedure.This includes monitoring the patient's vital signs, assessing for complications, and adjusting the dialysis prescription as needed.
- Medicine Services and Procedures > Dialysis Services and Procedures
- Medicine Services and Procedures > Dialysis Services and Procedures > Hemodialysis Procedures
In simple words: This code is used when someone gets hemodialysis (a blood cleaning treatment) and needs to be checked on multiple times during the treatment. The doctor might need to adjust the treatment plan based on how the person is doing.
This CPT code, 90937, reports hemodialysis procedures that necessitate multiple patient evaluations during the dialysis session.These evaluations may or may not lead to significant changes in the dialysis prescription.The code encompasses both inpatient end-stage renal disease (ESRD) and non-ESRD dialysis, as well as outpatient non-ESRD dialysis services.It's crucial to distinguish this from code 90935, which applies when only a single evaluation is performed during the hemodialysis procedure.
Example 1: A patient undergoing hemodialysis experiences a hypotensive episode (low blood pressure) mid-procedure. The physician must re-evaluate the patient, potentially adjusting fluid removal rates and administering medication, necessitating code 90937., A patient with ESRD requires hemodialysis and exhibits signs of respiratory distress. The physician must perform repeated evaluations throughout the dialysis session to monitor and manage this complication, justifying the use of code 90937., An outpatient with acute kidney injury (AKI) is receiving hemodialysis. The physician performs several re-evaluations due to fluctuating electrolyte levels and potential medication adjustments during the session, leading to the use of code 90937.
Detailed medical records documenting the hemodialysis procedure, including the patient's vital signs, any complications encountered, the number and nature of the re-evaluations performed, and any adjustments made to the dialysis prescription.Physician notes explaining the medical necessity for multiple evaluations during the dialysis session are crucial for proper coding and reimbursement.
** Accurate coding requires comprehensive documentation that justifies the medical necessity for multiple evaluations during the hemodialysis session.Any discrepancies between the provided information and the actual medical record should be thoroughly investigated and clarified with the physician to ensure proper coding.
- Revenue Code: P9A (Dialysis Services - Medicare Fee Schedule)
- RVU: Refer to the CMS fee schedule for the most up-to-date RVU values and reimbursement rates.These values vary based on location and facility type.
- Global Days: The global period for this code is not explicitly defined and should be determined by local guidelines or payer policies. It is likely to be influenced by the nature and frequency of the required re-evaluations.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule data is not readily available and would vary based on payer and year.Consult historical fee schedules for relevant periods.
- Specialties:Nephrology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center,Urgent Care Facility, Office