How To Use HCPCS Code G0384

HCPCS code G0384 describes a level 5 hospital emergency department visit provided in a type B emergency department. This code is used to identify a specific type of emergency department visit that meets certain requirements set by the Centers for Medicare and Medicaid Services (CMS). It is important for medical coders to understand the meaning and usage of this code in order to accurately report and bill for these services.

1. What is HCPCS G0384?

HCPCS code G0384 is used to identify a level 5 hospital emergency department visit provided in a type B emergency department. This code is specifically used for emergency department visits that meet certain requirements outlined by CMS. It is important to note that this code is only applicable for emergency department visits and should not be used for other types of visits or services.

2. Official Description

The official description of HCPCS code G0384 is “Level 5 hospital emergency department visit provided in a type B emergency department.” The short description for this code is “Lev 5 hosp type B ED visit.” These descriptions accurately reflect the purpose and nature of the services provided during a level 5 emergency department visit in a type B emergency department.

3. Procedure

1. Upon arrival at the emergency department, the patient’s condition and symptoms are assessed by the triage nurse.
2. The patient is then assigned a priority level based on the severity of their condition.
3. The patient is taken to an examination room where they are evaluated by a healthcare provider.
4. The healthcare provider performs a comprehensive examination, orders any necessary tests or procedures, and develops a treatment plan.
5. The patient may receive diagnostic tests, such as blood work or imaging studies, to aid in the diagnosis and treatment of their condition.
6. Treatment is provided based on the patient’s individual needs and may include medications, procedures, or referrals to specialists.
7. After the initial treatment, the patient may be discharged with instructions for follow-up care or admitted to the hospital for further treatment and observation.

4. When to use HCPCS code G0384

HCPCS code G0384 should be used when reporting a level 5 hospital emergency department visit provided in a type B emergency department. In order to use this code, the emergency department must meet at least one of the following requirements:

1. It is licensed by the state in which it is located under applicable state law as an emergency room or emergency department.
2. It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment.
3. During the calendar year immediately preceding the calendar year in which a determination under 42 CFR 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment.

5. Billing Guidelines and Documentation Requirements

When billing for a level 5 hospital emergency department visit using HCPCS code G0384, healthcare providers must ensure that the necessary documentation is in place to support the services provided. This may include:

• Documentation of the patient’s chief complaint and presenting symptoms.
• Documentation of the healthcare provider’s evaluation and examination of the patient.
• Documentation of any diagnostic tests or procedures performed.
• Documentation of the treatment provided, including medications administered or prescribed.
• Documentation of any referrals or consultations made.
• Documentation of the patient’s disposition, whether they were discharged or admitted to the hospital.

6. Historical Information and Code Maintenance

HCPCS code G0384 was added to the Healthcare Common Procedure Coding System on January 01, 2007. It has an effective date of January 01, 2008. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G0384 is payable by Medicare. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This code is typically bundled with other services provided during the emergency department visit. The multiple pricing indicator code is 9, which means that it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G0384 should be billed:

1. A patient presents to the emergency department with severe chest pain and is evaluated by a healthcare provider. The provider orders an EKG, blood work, and a chest X-ray. The patient is diagnosed with a heart attack and admitted to the hospital for further treatment.
2. A patient arrives at the emergency department with a deep laceration on their hand. The healthcare provider examines the wound, cleans it, and sutures it closed. The patient is discharged with instructions for wound care and a follow-up appointment with a hand surgeon.
3. A patient is brought to the emergency department by ambulance after being involved in a car accident. The healthcare provider evaluates the patient for any injuries and orders a CT scan of the head and neck. The patient is diagnosed with a concussion and discharged with instructions for rest and follow-up with their primary care physician.
4. A patient presents to the emergency department with difficulty breathing and chest tightness. The healthcare provider performs a thorough examination, orders a chest X-ray and blood gas analysis, and administers nebulized medications. The patient’s symptoms improve, and they are discharged with a prescription for an inhaler and instructions for follow-up with a pulmonologist.
5. A patient arrives at the emergency department with a high fever and severe abdominal pain. The healthcare provider evaluates the patient, orders blood work and a CT scan of the abdomen, and administers intravenous antibiotics. The patient is diagnosed with appendicitis and taken to the operating room for an emergency appendectomy.