How To Use HCPCS Code G1010

HCPCS code G1010 describes a clinical decision support mechanism known as Stanson, which is defined by the Medicare Appropriate Use Criteria (AUC) program. This code is used to identify and bill for the use of the Stanson clinical decision support tool in medical care settings. In this article, we will explore the details of HCPCS code G1010, 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 G1010?

HCPCS code G1010 is a specific code used to identify the clinical decision support mechanism Stanson, as defined by the Medicare AUC program. This code is used to indicate the use of the Stanson tool in medical care settings. It is important to note that this code is specific to the Stanson clinical decision support mechanism and should not be used for other similar tools or systems.

2. Official Description

The official description of HCPCS code G1010 is “Clinical decision support mechanism Stanson, as defined by the Medicare appropriate use criteria program.” The short description for this code is “Cdsm stanson.”

3. Procedure

1. The provider accesses the Stanson clinical decision support mechanism.
2. The provider enters the relevant patient information and clinical scenario into the Stanson tool.
3. The Stanson tool analyzes the input data and provides evidence-based recommendations or alerts to assist the provider in making clinical decisions.
4. The provider reviews the recommendations or alerts provided by the Stanson tool and incorporates them into the patient’s care plan as appropriate.
5. The provider documents the use of the Stanson tool and any actions taken based on its recommendations in the patient’s medical record.

4. When to use HCPCS code G1010

HCPCS code G1010 should be used when the Stanson clinical decision support mechanism is utilized in a medical care setting. This code is applicable when the provider accesses the Stanson tool, enters patient information and clinical scenarios, and utilizes the recommendations or alerts provided by the tool to guide clinical decision-making. It is important to ensure that the use of the Stanson tool meets the criteria set forth by the Medicare AUC program.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G1010, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the use of the Stanson clinical decision support mechanism in the patient’s medical record.
• Documentation of the patient information and clinical scenarios entered into the Stanson tool.
• Documentation of any recommendations or alerts provided by the Stanson tool and the actions taken based on those recommendations.

Providers should follow the billing guidelines set forth by Medicare or other insurance payers to ensure proper reimbursement for the use of the Stanson tool.

6. Historical Information and Code Maintenance

HCPCS code G1010 was added to the Healthcare Common Procedure Coding System on January 01, 2020. 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 to stay updated with any future changes or revisions to the code, as well as any updates to the Medicare AUC program.

7. Medicare and Insurance Coverage

HCPCS code G1010 is subject to Medicare and insurance coverage policies. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled with other services or not covered by Medicare. The multiple pricing indicator code is 9, which means that the value for this code is not established or not applicable as HCPCS is not priced separately by Part B. It is important for healthcare providers to verify coverage and reimbursement policies with Medicare or other insurance payers.

8. Examples

Here are five examples of scenarios in which HCPCS code G1010 should be billed:

1. A primary care physician uses the Stanson clinical decision support mechanism to guide the management of a patient with diabetes, following the evidence-based recommendations provided by the tool.
2. An orthopedic surgeon utilizes the Stanson tool to determine the appropriate imaging studies for a patient with suspected musculoskeletal pathology, based on the Medicare AUC program criteria.
3. A cardiologist accesses the Stanson clinical decision support mechanism to evaluate the appropriateness of a cardiac procedure for a patient with known heart disease, ensuring compliance with the Medicare AUC program requirements.
4. A gastroenterologist incorporates the recommendations provided by the Stanson tool into the management plan for a patient with gastrointestinal symptoms, ensuring adherence to evidence-based guidelines.
5. A radiologist uses the Stanson clinical decision support mechanism to assess the appropriateness of a requested imaging study, providing feedback to the referring physician based on the tool’s recommendations.