How To Use HCPCS Code G1027

HCPCS code G1027 describes the number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months.

1. What is HCPCS G1027?

HCPCS code G1027 is a specific code used in medical coding to identify the number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months. This code is used to track and report the utilization of this specific type of hemodialysis treatment.

2. Official Description

The official description of HCPCS code G1027 is “The number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months.” The short description for this code is “Pt hemo < 3mo."

3. Procedure

1. The provider should identify the adult patients who are on maintenance hemodialysis.
2. Determine if the patient is under the care of the same practitioner or group partner.
3. Verify that the patient has been using a catheter continuously for less than three months.
4. Count the number of adult patient-months in the denominator who meet the above criteria.

4. When to use HCPCS code G1027

HCPCS code G1027 should be used when reporting the number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months. It is important to accurately document and report this information for tracking and reimbursement purposes.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G1027, healthcare providers should ensure that the necessary documentation is in place to support the use of this code. This may include medical records, treatment plans, and any other relevant documentation that demonstrates the patient’s eligibility for this specific type of hemodialysis treatment. Providers should also follow the billing guidelines set forth by the payer, ensuring that all required information is included on the claim form.

6. Historical Information and Code Maintenance

HCPCS code G1027 was added to the Healthcare Common Procedure Coding System on January 01, 2022. 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 for medical coders to stay updated on any changes or revisions to this code in order to accurately report and bill for the services it represents.

7. Medicare and Insurance Coverage

The coverage and reimbursement for HCPCS code G1027 may vary depending on the payer. Medicare and other insurance providers may have specific guidelines and policies in place regarding the use of this code. It is important for healthcare providers to familiarize themselves with these guidelines to ensure proper reimbursement for the services rendered.

8. Examples

Here are five examples of when HCPCS code G1027 should be billed:

1. A 45-year-old patient who has been on maintenance hemodialysis for two months, under the care of the same practitioner, and using a catheter continuously.
2. A 60-year-old patient who has been on maintenance hemodialysis for one month, under the care of a group partner, and using a catheter continuously.
3. A 55-year-old patient who has been on maintenance hemodialysis for three months, under the care of the same practitioner, but not using a catheter continuously.
4. A 70-year-old patient who has been on maintenance hemodialysis for two months, under the care of a group partner, but not using a catheter continuously.
5. A 50-year-old patient who has been on maintenance hemodialysis for one month, not under the care of the same practitioner or group partner, and not using a catheter continuously.