How To Use HCPCS Code G9018

HCPCS code G9018 describes the inhalation powder medication Zanamivir, which is administered through an inhaler. This code is specifically used for the medication’s use in a Medicare-approved demonstration project. In this article, we will explore the details of HCPCS code G9018, 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 G9018?

HCPCS code G9018 is a specific code used to identify the inhalation powder medication Zanamivir, which is administered through an inhaler. This code is specifically used for the medication’s use in a Medicare-approved demonstration project. It is important to note that HCPCS codes are used for reporting medical procedures, services, and supplies for reimbursement purposes.

2. Official Description

The official description of HCPCS code G9018 is “Zanamivir, inhalation powder, administered through inhaler, per 10 mg.” The short description of this code is “Zanamivir, inhalation pwd 10m.”

3. Procedure

1. Prepare the inhaler device according to the manufacturer’s instructions.
2. Measure the prescribed dosage of Zanamivir inhalation powder, ensuring it is 10 mg.
3. Load the measured dosage into the inhaler device.
4. Instruct the patient on the proper technique for using the inhaler.
5. Monitor the patient during the inhalation process to ensure proper administration.
6. Document the administration of Zanamivir inhalation powder in the patient’s medical record.

4. When to use HCPCS code G9018

HCPCS code G9018 should be used when administering Zanamivir inhalation powder through an inhaler as part of a Medicare-approved demonstration project. It is important to verify the patient’s eligibility for the demonstration project and ensure that the use of Zanamivir inhalation powder is medically necessary for the patient’s condition.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9018, healthcare providers should ensure that the following documentation is included:

• Medical record documentation supporting the medical necessity of Zanamivir inhalation powder for the patient’s condition.
• Documentation of the dosage administered, including the measurement of 10 mg.
• Documentation of the inhaler device used and its proper preparation and administration.

6. Historical Information and Code Maintenance

HCPCS code G9018 was added to the Healthcare Common Procedure Coding System on December 01, 2004. It has a termination date of December 31, 2019. The termination of this code means that it is no longer valid for use in reporting medical procedures, services, or supplies. It is important to use the most up-to-date and applicable codes for accurate billing and reimbursement.

7. Medicare and Insurance Coverage

Medicare coverage for HCPCS code G9018 is subject to carrier judgment, indicated by the coverage code C. This means that Medicare will determine coverage based on their assessment of medical necessity and other relevant factors. The pricing indicator code for this code is 13, which indicates that the price for this service or supply is established by carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS is priced under one methodology. It is important to check with individual insurance providers regarding coverage and reimbursement for HCPCS code G9018.

8. Examples

Here are five examples of when HCPCS code G9018 should be billed:

1. A patient with a confirmed diagnosis of influenza is prescribed Zanamivir inhalation powder as part of a Medicare-approved demonstration project.
2. A healthcare provider administers Zanamivir inhalation powder through an inhaler to a patient with a documented medical necessity for the medication.
3. A patient with a history of respiratory conditions, such as asthma, is enrolled in a Medicare-approved demonstration project and requires Zanamivir inhalation powder for preventive purposes.
4. A patient with a compromised immune system due to a medical condition is prescribed Zanamivir inhalation powder to reduce the risk of respiratory infections.
5. A healthcare provider participates in a Medicare-approved demonstration project focused on evaluating the effectiveness of Zanamivir inhalation powder in managing respiratory symptoms.