How To Use HCPCS Code G0164

HCPCS code G0164 describes the skilled services of a licensed nurse (LPN or RN) in the training and/or education of a patient or family member in the home health or hospice setting, with each session lasting 15 minutes. This code is used to identify and bill for the specific services provided by a nurse in educating and training patients or their family members in a home health or hospice environment.

1. What is HCPCS G0164?

HCPCS code G0164 is a specific code used in medical coding to identify and bill for the skilled services of a licensed nurse in the training and education of a patient or family member in the home health or hospice setting. This code is used to indicate that a nurse has provided educational and training services to help patients or their family members understand and manage their healthcare needs in the comfort of their own home.

2. Official Description

The official description of HCPCS code G0164 is “Skilled services of a licensed nurse (LPN or RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.” The short description for this code is “Hhc lis nurse train ea 15.”

3. Procedure

1. The nurse assesses the educational needs of the patient or family member.
2. The nurse develops an individualized training plan based on the patient’s specific needs and goals.
3. The nurse provides instruction and training on various healthcare topics, such as medication management, wound care, disease management, and self-care techniques.
4. The nurse evaluates the patient’s understanding and progress, and adjusts the training plan as necessary.
5. The nurse documents the services provided, including the topics covered, the duration of each session, and the patient’s response to the training.

4. When to use HCPCS code G0164

HCPCS code G0164 should be used when a licensed nurse provides skilled services in the training and education of a patient or family member in the home health or hospice setting. This code is applicable when the nurse’s services involve teaching and instructing the patient or family member on healthcare-related topics to improve their understanding and ability to manage their health condition at home.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0164, healthcare providers need to document the following:

• The date and duration of each training session
• The specific topics covered during each session
• The patient’s response and progress during the training
• The credentials of the licensed nurse providing the services

Providers should also ensure that the documentation supports the medical necessity of the training and education services provided.

6. Historical Information and Code Maintenance

HCPCS code G0164 was added to the Healthcare Common Procedure Coding System on January 1, 2011. It has a pricing indicator code of 00, which means the service is not separately priced by Part B. The code has a multiple pricing indicator code of 9, indicating that it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

It is important to note that HCPCS code G0164 was terminated on December 31, 2016. This means that it is no longer valid for billing purposes after this date.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the skilled services provided under HCPCS code G0164, but coverage may vary depending on the specific plan and guidelines. Providers should check with the payer to determine the coverage and reimbursement policies for this code.

8. Examples

Here are five examples of when HCPCS code G0164 may be billed:

1. A licensed nurse provides training and education to a patient with diabetes on how to monitor blood glucose levels, administer insulin injections, and manage diet and exercise.
2. A nurse conducts training sessions with a family member of a patient with a chronic respiratory condition, teaching them how to properly use and maintain respiratory equipment.
3. A licensed nurse provides education and training to a patient recovering from surgery on wound care, including dressing changes and signs of infection.
4. A nurse conducts training sessions with a family member of a patient with a neurological disorder, teaching them techniques for assisting with mobility and activities of daily living.
5. A licensed nurse provides education and training to a patient with heart disease on medication management, including dosage instructions and potential side effects.