How To Use HCPCS Code G1012

HCPCS code G1012 describes a clinical decision support mechanism called AgileMD, which is defined by the Medicare Appropriate Use Criteria (AUC) program. This code is used to identify and bill for the use of AgileMD in medical care settings. In this article, we will explore the details of HCPCS code G1012, 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 G1012?

HCPCS code G1012 is a specific code used to identify the clinical decision support mechanism AgileMD. This code is part of the Healthcare Common Procedure Coding System (HCPCS) and is used in medical coding and billing to accurately document and bill for the use of AgileMD in medical care settings. It is important for medical coders and healthcare providers to correctly assign this code to ensure accurate reimbursement and tracking of the use of AgileMD.

2. Official Description

The official description of HCPCS code G1012 is “Clinical decision support mechanism AgileMD, as defined by the Medicare Appropriate Use Criteria program.” This description highlights that AgileMD is a clinical decision support mechanism that is specifically defined by the Medicare Appropriate Use Criteria program. The short description of this code is “Cdsm AgileMD.”

3. Procedure

1. Step 1: Determine the need for clinical decision support.
2. Step 2: Access the AgileMD platform or software.
3. Step 3: Enter patient information and relevant clinical data.
4. Step 4: Utilize AgileMD to access evidence-based guidelines and recommendations.
5. Step 5: Apply the recommendations to the patient’s specific case.
6. Step 6: Document the use of AgileMD in the patient’s medical record.

The procedure for using HCPCS code G1012 involves the healthcare provider utilizing the AgileMD platform or software to access evidence-based guidelines and recommendations for clinical decision-making. The provider enters patient information and relevant clinical data into AgileMD and applies the recommendations to the patient’s specific case. It is important to document the use of AgileMD in the patient’s medical record to support accurate billing and reimbursement.

4. When to use HCPCS code G1012

HCPCS code G1012 should be used when a healthcare provider utilizes the AgileMD clinical decision support mechanism in the medical care setting. This code is specifically used to identify and bill for the use of AgileMD as defined by the Medicare Appropriate Use Criteria program. It is important to ensure that the use of AgileMD meets the criteria and guidelines set forth by the program to accurately assign this code.

5. Billing Guidelines and Documentation Requirements

When billing for the use of HCPCS code G1012, healthcare providers need to ensure proper documentation of the use of AgileMD in the patient’s medical record. This documentation should include the date and time of the use of AgileMD, the specific recommendations or guidelines accessed, and any actions taken based on the recommendations. It is important to follow the billing guidelines set forth by Medicare and other insurance providers to ensure accurate reimbursement for the use of AgileMD.

6. Historical Information and Code Maintenance

HCPCS code G1012 was added to the Healthcare Common Procedure Coding System on April 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. This code is relatively new and does not have a historical context of significant changes since its addition.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may provide coverage for the use of HCPCS code G1012, depending on the specific guidelines and policies. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This indicates that the service may be bundled or not covered separately. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS is not priced separately by Part B or the value is not established. It is important to verify coverage and reimbursement policies with the respective insurance providers.

8. Examples

Here are five examples of when HCPCS code G1012 should be billed:

1. A primary care physician uses AgileMD to access evidence-based guidelines for managing a patient’s chronic condition.
2. An oncologist utilizes AgileMD to determine the most appropriate treatment plan for a cancer patient based on the latest research and recommendations.
3. A cardiologist uses AgileMD to guide the decision-making process for selecting the appropriate diagnostic tests for a patient with suspected heart disease.
4. An emergency room physician utilizes AgileMD to quickly access guidelines for managing a patient with a complex medical condition.
5. A surgeon uses AgileMD to ensure adherence to best practices and guidelines during a surgical procedure.