How To Use HCPCS Code G8996

HCPCS code G8996 describes the current status of swallowing functional limitation at the therapy episode outset and at reporting intervals. This code is used to identify and document the level of impairment in swallowing function for patients receiving therapy.

1. What is HCPCS G8996?

HCPCS code G8996 is a specific code used in medical coding to indicate the current status of swallowing functional limitation. It is used to track and document the level of impairment in swallowing function for patients who are undergoing therapy.

2. Official Description

The official description of HCPCS code G8996 is “Swallowing functional limitation, current status at therapy episode outset and at reporting intervals.” The short description for this code is “Swallow current status.”

3. Procedure

1. The provider assesses the patient’s swallowing function at the therapy episode outset.
2. The provider evaluates the patient’s ability to swallow and identifies any functional limitations.
3. The provider documents the current status of the patient’s swallowing function.
4. Throughout the therapy sessions, the provider periodically reassesses the patient’s swallowing function and updates the documentation accordingly.

4. When to use HCPCS code G8996

HCPCS code G8996 should be used when documenting the current status of swallowing functional limitation at the therapy episode outset and at reporting intervals. It is typically used for patients who require therapy to address swallowing difficulties.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8996, healthcare providers should ensure that the documentation clearly indicates the patient’s current status of swallowing functional limitation. This may include details on the severity of the limitation, any specific challenges faced by the patient, and the impact on their overall health and well-being.

6. Historical Information and Code Maintenance

HCPCS code G8996 was added to the Healthcare Common Procedure Coding System on January 1, 2013. It has a coverage code of C, which indicates that the determination of coverage is based on carrier judgment. The code has no maintenance actions, as indicated by the action code N.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the use of HCPCS code G8996, but the coverage and reimbursement may vary. Providers should refer to the specific guidelines and policies of the respective payers to determine the coverage and reimbursement for this code.

8. Examples

Here are five examples of when HCPCS code G8996 should be billed:

1. A patient with a history of stroke undergoes therapy to improve their swallowing function. The provider assesses the patient’s swallowing functional limitation at the therapy episode outset and periodically throughout the treatment.
2. An elderly patient with a neurodegenerative disorder receives therapy to manage their swallowing difficulties. The provider documents the current status of the patient’s swallowing function at the therapy episode outset and updates it during subsequent reporting intervals.
3. A patient recovering from head and neck cancer undergoes therapy to address swallowing impairments caused by the treatment. The provider assesses and documents the patient’s swallowing functional limitation at the therapy episode outset and monitors it throughout the treatment course.
4. A child with a developmental disorder receives therapy to improve their swallowing function. The provider evaluates the child’s swallowing functional limitation at the therapy episode outset and tracks their progress through reporting intervals.
5. A patient with a traumatic brain injury undergoes therapy to rehabilitate their swallowing function. The provider assesses the patient’s swallowing functional limitation at the therapy episode outset and periodically updates the documentation to reflect any changes in their condition.