Summary & Overview
CPT 90947: Dialysis Procedure Other Than Hemodialysis, Repeated Evaluation
CPT code 90947 covers dialysis procedures other than hemodialysis, including peritoneal dialysis and hemofiltration, when repeated evaluations are required. This code is significant for hospitals and nephrology practices nationwide, as it addresses complex cases where ongoing assessment and potential revision of the dialysis prescription are necessary. The procedure is most commonly performed in inpatient hospital settings, with evaluation and management services bundled into the billing.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare recognize and reimburse for CPT code 90947. The publication provides a comprehensive overview of payer coverage, clinical indications, and billing benchmarks for this code. Readers will gain insight into policy updates, typical clinical scenarios, and how this code fits within the broader context of dialysis services. The summary also highlights related codes and modifiers, offering clarity on distinctions between various dialysis procedures and their documentation requirements.
Healthcare professionals and administrators will find this resource valuable for understanding the clinical and billing landscape of dialysis services beyond hemodialysis, ensuring accurate reporting and compliance with payer policies.
CPT Code Overview
CPT code 90947 is used to report dialysis procedures other than hemodialysis, such as peritoneal dialysis or hemofiltration, that require repeated evaluations. This code applies whether or not there is substantial revision of the dialysis prescription during the course of treatment. The service type is classified as Miscellaneous Dialysis Services and Procedures, and it is typically performed in an inpatient hospital setting, where evaluation and management services are bundled.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult admitted to an inpatient hospital setting with acute or chronic renal failure, fluid overload, or significant electrolyte disturbances such as hyperpotassemia or acidosis. The patient is not a candidate for hemodialysis due to clinical factors or preference. The nephrology or internal medicine physician evaluates the patient repeatedly throughout the day, adjusts the dialysis prescription as needed, and oversees a dialysis procedure other than hemodialysis (e.g., peritoneal dialysis or hemofiltration). The service is bundled with evaluation and management (E/M) in the inpatient setting, and may require substantial revision of the dialysis plan based on ongoing clinical assessments.
Coding Specifications
- Modifier
25: Used to indicate a significant, separately identifiable evaluation and management service by the same physician on the same day as the dialysis procedure. This is applicable when the physician provides an E/M service that is distinct from the dialysis procedure.
| Provider Taxonomy Code | Specialty |
|---|---|
207RN0300X | Nephrology Physician |
208800000X | Urology Physician |