How To Use HCPCS Code G0036

HCPCS code G0036 describes a specific assessment scenario where a patient or their care partner declines to undergo an assessment. This code is used to indicate that the patient or their care partner has chosen not to participate in the assessment process. It is important for medical coders to understand the meaning and usage of this code to accurately document and bill for the services provided.

1. What is HCPCS G0036?

HCPCS code G0036 is used to identify situations where a patient or their care partner declines to undergo an assessment. This code is specifically designed to capture instances where the patient or their care partner chooses not to participate in the assessment process. It is important to note that this code should only be used when the patient or their care partner actively declines the assessment, and not in cases where the assessment is not performed due to other reasons.

2. Official Description

The official description of HCPCS code G0036 is “Patient or care partner decline assessment.” The short description for this code is “Pt/ptn decln assess.” These descriptions accurately reflect the purpose of this code, which is to indicate that the patient or their care partner has chosen not to undergo the assessment process.

3. Procedure

1. The provider should inform the patient or their care partner about the assessment process and its importance in their healthcare management.
2. If the patient or their care partner declines the assessment, the provider should document this decision in the patient’s medical record.
3. The provider should also ensure that the patient or their care partner understands the potential implications of declining the assessment.
4. Any relevant discussions or conversations regarding the decision to decline the assessment should be documented in the medical record.

4. When to use HCPCS code G0036

HCPCS code G0036 should be used when the patient or their care partner actively declines to undergo the assessment process. It is important to accurately document this decision to ensure proper communication and coordination of care. This code should not be used in cases where the assessment is not performed due to other reasons, such as medical contraindications or unavailability of assessment tools.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0036, healthcare providers should ensure that the patient’s medical record clearly reflects the patient or their care partner’s decision to decline the assessment. This documentation should include the date and time of the discussion, the reasons for declining the assessment, and any relevant conversations or discussions regarding the decision. Proper documentation is crucial for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G0036 was added to the Healthcare Common Procedure Coding System on January 01, 2022. As of the effective date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders to stay updated on any future changes or revisions to this code.

7. Medicare and Insurance Coverage

HCPCS code G0036 is covered by Medicare and other insurance providers. However, it is important to note that this code is not separately priced by Part B. The pricing indicator code 00 indicates that the service is not separately priced, as it may be bundled with other services or not covered under certain circumstances. The multiple pricing indicator code 9 further indicates that the value for this code is not established. Medical coders should refer to the specific guidelines and policies of Medicare and other insurance providers for accurate billing and reimbursement.

8. Examples

Here are five examples of scenarios where HCPCS code G0036 should be billed:

1. A patient declines to undergo a comprehensive assessment for their chronic condition management.
2. A care partner refuses to participate in an assessment for a patient’s home healthcare needs.
3. A patient declines to undergo a cognitive assessment for memory-related concerns.
4. A care partner chooses not to participate in an assessment for a patient’s rehabilitation progress.
5. A patient declines to undergo a functional assessment for disability determination purposes.