How To Use HCPCS Code G8997

HCPCS code G8997 describes the swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting. This code is used to indicate the status of a patient’s swallowing function and the goals set for therapy sessions. In this article, we will explore the details of HCPCS code G8997, 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 G8997?

HCPCS code G8997 is used to identify the swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting. It provides information on the patient’s swallowing function and the goals set for therapy sessions. This code helps in tracking the progress of the patient’s swallowing function throughout the therapy episode.

2. Official Description

The official description of HCPCS code G8997 is “Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting.” The short description for this code is “Swallow goal status.”

3. Procedure

1. The provider assesses the patient’s swallowing function at the beginning of the therapy episode.
2. The provider sets projected goals for the patient’s swallowing function based on the assessment.
3. Throughout the therapy episode, the provider periodically evaluates the patient’s progress and updates the goal status accordingly.
4. At the end of the therapy episode or when reporting ends, the provider assesses the final swallowing functional limitation and goal status.

4. When to use HCPCS code G8997

HCPCS code G8997 should be used when documenting the swallowing functional limitation and projected goal status at the therapy episode outset, at reporting intervals, and at discharge or to end reporting. It is important to use this code accurately to reflect the patient’s progress and the goals set for therapy sessions.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8997, healthcare providers need to document the patient’s swallowing functional limitation, the projected goal status at the therapy episode outset, at reporting intervals, and at discharge or to end reporting. The documentation should clearly indicate the progress made by the patient and any changes in the goal status throughout the therapy episode.

6. Historical Information and Code Maintenance

HCPCS code G8997 was added to the Healthcare Common Procedure Coding System on January 01, 2013. It has a coverage code of C, which indicates that carrier judgment is used for coverage. The code has an action code of N, meaning no maintenance for this code. The code’s action effective date is January 01, 2020. The pricing indicator code for HCPCS code G8997 is 00, indicating that the service is not separately priced by Part B. There is no multiple pricing indicator code assigned to this code.

7. Medicare and Insurance Coverage

HCPCS code G8997 is payable by Medicare and other insurance providers. The pricing indicator code 00 indicates that the service is not separately priced by Part B. This means that the service is either not covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS code G8997 is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G8997 should be billed:

1. A patient with a swallowing functional limitation undergoes therapy sessions to improve their swallowing function. The provider assesses the goal status at the therapy episode outset and periodically updates it based on the patient’s progress.
2. A patient with a history of swallowing difficulties starts therapy sessions to address their swallowing functional limitation. The provider sets projected goals for the therapy episode and evaluates the goal status at reporting intervals.
3. A patient with a recent surgery affecting their swallowing function receives therapy sessions to regain their swallowing abilities. The provider assesses the goal status at the therapy episode outset and monitors the progress throughout the therapy episode.
4. A patient with a chronic condition that affects their swallowing function undergoes therapy sessions to manage their swallowing functional limitation. The provider updates the goal status at reporting intervals and assesses the final goal status at discharge.
5. A patient with a temporary swallowing functional limitation due to an injury receives therapy sessions to restore their swallowing abilities. The provider evaluates the goal status at the therapy episode outset and adjusts it based on the patient’s progress.