How To Use HCPCS Code G1009

HCPCS code G1009 describes the clinical decision support mechanism Sage Health Management Solutions, as defined by the Medicare Appropriate Use Criteria program. This code is used to identify the use of Sage Health Management Solutions in clinical decision-making processes.

1. What is HCPCS G1009?

HCPCS code G1009 is a specific code used in medical coding to identify the use of the clinical decision support mechanism Sage Health Management Solutions. This code is part of the Healthcare Common Procedure Coding System (HCPCS) and is used to accurately document and bill for the use of this specific tool in healthcare settings.

2. Official Description

The official description of HCPCS code G1009 is “Clinical decision support mechanism Sage Health Management Solutions, as defined by the Medicare Appropriate Use Criteria program.” The short description for this code is “Cdsm sage health.”

3. Procedure

1. Providers utilize Sage Health Management Solutions as a clinical decision support mechanism.
2. The tool assists healthcare professionals in making informed decisions by providing evidence-based recommendations and guidelines.
3. Providers input patient-specific information into the system, such as medical history, symptoms, and test results.
4. Sage Health Management Solutions analyzes the data and generates recommendations based on established criteria and guidelines.
5. Healthcare professionals review the recommendations and use them to guide their clinical decision-making process.
6. The use of Sage Health Management Solutions helps improve the quality of care and ensures that appropriate and evidence-based decisions are made.

4. When to use HCPCS code G1009

HCPCS code G1009 should be used when healthcare providers utilize the clinical decision support mechanism Sage Health Management Solutions in their clinical decision-making processes. This code is used to accurately document and bill for the use of this specific tool.

5. Billing Guidelines and Documentation Requirements

When billing for the use of HCPCS code G1009, healthcare providers need to ensure that the following documentation requirements are met:

• Documentation should clearly indicate the use of Sage Health Management Solutions in the clinical decision-making process.
• Providers should include the patient-specific information entered into the system and any recommendations generated by the tool.
• It is important to accurately capture the date and time of the use of Sage Health Management Solutions.

6. Historical Information and Code Maintenance

HCPCS code G1009 was added to the Healthcare Common Procedure Coding System on January 01, 2020. It has an effective date of April 01, 2022. As of March 31, 2022, this code has been terminated and is no longer in use. The termination of this code means that it is no longer valid for billing purposes.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G1009 may vary. It is important for healthcare providers to check with the specific payer to determine if this code is payable. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value is not established or the code is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G1009 should be billed:

1. A primary care physician uses Sage Health Management Solutions to assist in determining the appropriate diagnostic tests for a patient presenting with specific symptoms.
2. An oncologist utilizes Sage Health Management Solutions to guide treatment decisions for a patient with a specific type of cancer.
3. A cardiologist incorporates Sage Health Management Solutions into the evaluation and management of patients with cardiovascular conditions.
4. A psychiatrist uses Sage Health Management Solutions to support the diagnosis and treatment planning for patients with mental health disorders.
5. An orthopedic surgeon utilizes Sage Health Management Solutions to assist in determining the most appropriate surgical approach for a patient with a musculoskeletal condition.