How To Use HCPCS Code G0406

HCPCS code G0406 describes a follow-up inpatient consultation that is typically conducted via telehealth. This code is used when physicians spend approximately 15 minutes communicating with the patient remotely. In this article, we will explore the details of HCPCS code G0406, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0406?

HCPCS code G0406 is used to identify a follow-up inpatient consultation that is conducted via telehealth. It is specifically used when physicians spend approximately 15 minutes communicating with the patient remotely. This code allows healthcare providers to accurately document and bill for this specific type of consultation.

2. Official Description

The official description of HCPCS code G0406 is “Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth.” The short description for this code is “Inpt/tele follow up 15.”

3. Procedure

1. The provider initiates the follow-up inpatient consultation via telehealth.
2. They spend approximately 15 minutes communicating with the patient, discussing their condition, treatment plan, and addressing any concerns or questions.
3. The consultation may involve reviewing medical records, test results, and discussing any necessary adjustments to the patient’s care plan.
4. Documentation of the consultation should include the date, time, duration, and a summary of the discussion.

4. When to use HCPCS code G0406

HCPCS code G0406 should be used in the context of a follow-up inpatient consultation conducted via telehealth. It is important to ensure that the consultation meets the criteria outlined in the official description, including the limited duration of approximately 15 minutes. This code should not be used for initial consultations or consultations that exceed the specified time frame.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0406, healthcare providers should ensure that the documentation supports the use of telehealth for the follow-up inpatient consultation. This may include documenting the use of telecommunication technology, the duration of the consultation, and the content of the discussion. It is important to follow the specific billing guidelines provided by Medicare or other insurance carriers to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G0406 was added to the Healthcare Common Procedure Coding System on January 01, 2009. It has an effective date of January 01, 2012. As indicated by the action code N, there have been no maintenance actions taken for this code. This means that there have been no updates or revisions since its addition to the coding system.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G0406 may vary depending on the payer. Medicare considers this code as a carrier judgment, meaning that coverage is determined by the individual carrier’s policies. Other insurance carriers may have their own coverage determinations for this code. It is important to verify coverage with the specific payer before providing the service.

8. Examples

Here are five examples of scenarios where HCPCS code G0406 should be billed:

1. A patient is admitted to the hospital for a specific condition, and the physician conducts a follow-up consultation via telehealth to discuss the progress of the treatment plan.
2. An inpatient undergoes a surgical procedure, and the physician follows up with a telehealth consultation to assess the patient’s recovery and address any post-operative concerns.
3. A patient with a chronic illness is receiving inpatient care, and the physician conducts a telehealth consultation to review the management of the condition and make any necessary adjustments to the treatment plan.
4. An inpatient has recently undergone diagnostic tests, and the physician conducts a telehealth consultation to discuss the results and provide further guidance on the next steps of the patient’s care.
5. A patient is admitted to the hospital with a complex medical condition, and the physician conducts a telehealth consultation to coordinate care with other specialists and ensure a comprehensive treatment approach.