How To Use HCPCS Code G2097

HCPCS code G2097 describes episodes where the patient had a competing diagnosis on or within three days after the episode date. This code is used to identify cases where a patient is diagnosed with a respiratory infection (URI) three days after being diagnosed with another condition. The code is specific to cases where the patient has a competing diagnosis, such as intestinal infection, pertussis, bacterial infection, Lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis, or UTI.

1. What is HCPCS G2097?

HCPCS code G2097 is used to identify episodes where a patient is diagnosed with a respiratory infection (URI) three days after being diagnosed with another condition. It is important to note that this code is only applicable when there is a competing diagnosis within the specified timeframe.

2. Official Description

The official description of HCPCS code G2097 is “Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or UTI).” The short description for this code is “Dx uri 3d after other dx.”

3. Procedure

1. The provider should first diagnose the patient with the initial condition or diagnosis.
2. Within three days after the initial diagnosis, the provider should diagnose the patient with a respiratory infection (URI).
3. The provider should document both diagnoses accurately and ensure that the competing diagnosis is clearly identified as being within the specified timeframe.

4. When to use HCPCS code G2097

HCPCS code G2097 should be used when a patient is diagnosed with a respiratory infection (URI) three days after being diagnosed with another condition. It is important to note that this code is only applicable when there is a competing diagnosis within the specified timeframe. Providers should carefully review the patient’s medical history and documentation to determine if this code is appropriate.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G2097, healthcare providers need to ensure that both the initial diagnosis and the respiratory infection (URI) diagnosis are accurately documented. The documentation should clearly indicate the competing diagnosis and the timeframe within which it occurred. It is important to provide sufficient information to support the use of this code and justify the medical necessity of the services provided.

6. Historical Information and Code Maintenance

HCPCS code G2097 was added to the Healthcare Common Procedure Coding System on January 01, 2020. As of January 01, 2022, 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 the code to ensure accurate reporting and billing.

7. Medicare and Insurance Coverage

The coverage for HCPCS code G2097 is determined by carrier judgment (coverage code C). The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. It is important for healthcare providers to check with Medicare and other insurance carriers to determine the specific coverage and reimbursement policies for this code.

8. Examples

Here are five examples of when HCPCS code G2097 should be billed:

1. A patient is diagnosed with a urinary tract infection (UTI) and three days later is diagnosed with a respiratory infection (URI).
2. A patient is diagnosed with cellulitis and three days later is diagnosed with a respiratory infection (URI).
3. A patient is diagnosed with pneumonia and three days later is diagnosed with a respiratory infection (URI).
4. A patient is diagnosed with prostatitis and three days later is diagnosed with a respiratory infection (URI).
5. A patient is diagnosed with acute sinusitis and three days later is diagnosed with a respiratory infection (URI).