How To Use HCPCS Code G2164

HCPCS code G2164 describes a specific situation where a patient has had a prior adverse reaction to the influenza virus vaccine at any time before or during the measurement period. This code is used to identify and document this particular circumstance for medical coding and billing purposes.

1. What is HCPCS G2164?

HCPCS code G2164 is a unique alphanumeric code that is part of the Healthcare Common Procedure Coding System (HCPCS). It is used to classify and identify specific medical procedures, services, and supplies provided by healthcare professionals. In the case of G2164, it specifically refers to a patient who has experienced an adverse reaction to the influenza virus vaccine.

2. Official Description

The official description of HCPCS code G2164 is as follows: “Patient had a prior influenza virus vaccine adverse reaction any time before or during the measurement period.” This description clearly indicates that this code is used to indicate a patient’s history of adverse reactions to the influenza virus vaccine.

3. Procedure

1. The healthcare provider should review the patient’s medical records to confirm the prior adverse reaction to the influenza virus vaccine.
2. If the patient has a documented adverse reaction, the provider should note the details of the reaction, including the symptoms experienced and the severity of the reaction.
3. The provider should also document the date of the adverse reaction, whether it occurred before or during the measurement period.
4. All relevant information should be accurately recorded in the patient’s medical records for proper coding and billing purposes.

4. When to use HCPCS code G2164

HCPCS code G2164 should be used when a patient has a documented history of adverse reactions to the influenza virus vaccine. This code is specifically used to indicate that the patient has experienced such a reaction at any time before or during the measurement period. It is important to use this code accurately and only when the patient meets the specified criteria.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies related to HCPCS code G2164, healthcare providers need to ensure proper documentation. The medical records should clearly indicate the patient’s prior adverse reaction to the influenza virus vaccine, including the details of the reaction, its severity, and the date it occurred. Accurate and thorough documentation is essential for proper coding and billing.

6. Historical Information and Code Maintenance

HCPCS code G2164 was added to the Healthcare Common Procedure Coding System on January 1, 2020. It has an effective date of January 1, 2021. As of December 31, 2020, this code has been terminated. The termination of a code means that it is no longer valid for use in medical coding and billing. It is important for healthcare professionals to stay updated on code changes and ensure they are using the most current codes for accurate billing.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may have specific coverage policies for HCPCS code G2164. It is important to check with the respective payers to determine if this code is payable and to understand any specific requirements or guidelines for reimbursement. The pricing indicator code for G2164 is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code G2164 should be billed:

1. A patient presents for a routine influenza vaccination and has a documented history of an adverse reaction to the vaccine in the past.
2. A healthcare provider administers the influenza virus vaccine to a patient and the patient experiences an adverse reaction during the measurement period.
3. A patient visits a healthcare facility for a medical evaluation and discloses a prior adverse reaction to the influenza virus vaccine.
4. A healthcare provider reviews a patient’s medical records and discovers a documented adverse reaction to the influenza virus vaccine that occurred before the measurement period.
5. A patient seeks medical attention after experiencing an adverse reaction to the influenza virus vaccine and the provider notes the reaction in the patient’s medical records.