CPT 90937: Peritoneal Dialysis Catheter Check – Billing & Documentation

CPT 90937 = Peritoneal dialysis catheter check, includes assessment of catheter site and determination of catheter patency and function.

When to Bill

• Routine catheter evaluation (function, flow, infection signs)
• Post-insertion check (typically 2–4 weeks after placement)
• Troubleshooting: poor inflow/outflow, leakage, pain, suspected migration
• Pre-dialysis assessment

Documentation Requirements (Medicare / Payer Expectations)

• Medical necessity: Why now? (routine surveillance, symptom-driven, post-op)
• Date of service, place of service (POS 11 office, 22 outpatient hospital)
• Provider signature + credentials (NPI)
• Patient identifiers
• Procedure description:
  • Catheter type (Tenckhoff, swan-neck, etc.), cuff position
  • Site inspection: erythema, drainage, granulation, cuff exposure
  • Patency test: inflow/outflow volumes, dwell time, resistance
  • Dialysate appearance: clear, cloudy, bloody
  • Flow rates (mL/min)
• Findings & Assessment: Functional / partial obstruction / malfunction / infection
• Plan: Flush (tPA, saline), reposition, replace, antibiotics, imaging, surgery referral

Billing Nuances

• Global period: Catheter insertion (CPT 49421) has 10-day global. 90937 not separately billable during global for same provider unless modifier 24 (unrelated E/M) or 58 (staged).
• E/M vs. 90937: If significant separately identifiable E/M performed (e.g., new complaint), bill E/M + 90937 with modifier 25.
• Frequency: Medicare expects ~monthly for stable PD patients. More frequent = medical necessity documentation.
• Reimbursement: ~$40–80 (MPFS, varies by GPCI). Facility fee separate if POS 22.

Common Denial Reasons

• Billed during global period without modifier
• Insufficient documentation of medical necessity
• Bundled into monthly capitation (MCP) for ESRD patients
• Performed by non-qualified provider (must be physician/NP/PA per state scope)

Accurate documentation = clean claims + quality care.