In simple words: This code is for doctors who manage the daily care of a dialysis patient (age 20 or older) with kidney failure for less than a full month.It's used when the patient has less than a full month of dialysis due to various reasons, such as hospitalization, travel, or a kidney transplant.

This CPT code, 90970, reports end-stage renal disease (ESRD)-related services for dialysis provided for less than a full month, billed on a per-day basis.It applies to patients aged 20 and older.The code encompasses daily management of ESRD-related services, including but not limited to:outpatient evaluation and management of dialysis visits, telephone calls, and patient management during dialysis.This code is used in situations involving transient patients, partial months with fewer than the required face-to-face visits, hospitalization preceding a complete assessment, dialysis cessation due to recovery or death, or a patient receiving a kidney transplant.Each month is considered 30 days for billing purposes.This code should not be reported in the same month with codes 99424, 99425, 99426, 99427, 99437, 99439, 99487, 99489, 99490, 99491.

Example 1: A 25-year-old patient with ESRD starts home dialysis on July 15th and undergoes a kidney transplant on July 28th. Code 90970 would be billed for each day of service from July 15th to July 27th., A 60-year-old ESRD patient is hospitalized from July 5th to July 18th.Following discharge, they receive two outpatient dialysis sessions before transferring to a different provider.Code 90970 would be billed for the days after discharge, and appropriate inpatient codes for the hospitalization period., A 32-year-old transient ESRD patient receives dialysis services for only 10 days in August while traveling. Code 90970 is billed for each of those 10 days.

Detailed medical records including the diagnosis of ESRD, dates of service, number of face-to-face visits, reason for less than a full month of service (e.g., hospitalization, transplant, death), and any other relevant clinical information are required.Documentation supporting medical necessity is essential.

** This code is part of a set of codes for managing ESRD patients, with different codes for different age groups and service durations.Always refer to the most up-to-date CPT codebook and payer guidelines for accurate coding and reimbursement.