How To Use HCPCS Code G9160

HCPCS code G9160 describes the functional limitation of spoken language comprehension and the projected goal status at the therapy episode outset, reporting intervals, and discharge or end of reporting. This code is used to identify and track the progress of patients with speech and language impairments during therapy sessions.

1. What is HCPCS G9160?

HCPCS code G9160 is a specific code used in medical coding to represent the functional limitation of spoken language comprehension and the projected goal status at various stages of therapy. It helps healthcare providers and insurers track the progress and outcomes of therapy sessions for patients with speech and language impairments.

2. Official Description

The official description of HCPCS code G9160 is “Spoken language comprehension 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 “Lang comp goal status.”

3. Procedure

1. During the therapy episode outset, the healthcare provider assesses the patient’s spoken language comprehension abilities.
2. The provider sets projected goals for the patient’s spoken language comprehension improvement.
3. At reporting intervals, the provider evaluates the patient’s progress towards the projected goals.
4. At discharge or the end of reporting, the provider determines the final goal status of the patient’s spoken language comprehension.

4. When to use HCPCS code G9160

HCPCS code G9160 is used when documenting and reporting the functional limitation of spoken language comprehension and the projected goal status for patients undergoing therapy for speech and language impairments. It is important to use this code accurately and in the appropriate context to ensure proper tracking and reimbursement.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9160, healthcare providers need to document the patient’s initial spoken language comprehension abilities, the projected goals for improvement, and the progress made at reporting intervals. The documentation should also include the final goal status at discharge or the end of reporting. Proper documentation is crucial for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9160 was added to the Healthcare Common Procedure Coding System on January 1, 2013. It has a coverage code of C, indicating carrier judgment. The code has no maintenance actions, as indicated by the action code N, meaning no maintenance for this code. It was terminated on December 31, 2019.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the services associated with HCPCS code G9160. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value is not established or the code is not priced separately by Part B. It is important to check with individual payers for specific coverage and reimbursement guidelines.

8. Examples

Here are five examples of when HCPCS code G9160 should be billed:

1. A patient with a history of stroke undergoes speech therapy to improve their spoken language comprehension. The therapy sessions include assessments, goal setting, progress evaluations, and final goal status determination.
2. A child with a developmental delay receives speech therapy to enhance their spoken language comprehension. The therapy sessions involve initial assessments, goal establishment, progress monitoring, and final goal status determination.
3. An adult with a traumatic brain injury undergoes speech and language therapy to regain their spoken language comprehension abilities. The therapy sessions include initial evaluations, goal planning, progress assessments, and final goal status determination.
4. A patient with a neurodegenerative disorder receives speech therapy to maintain their current level of spoken language comprehension. The therapy sessions involve regular progress evaluations and goal status updates.
5. An individual with a language processing disorder undergoes therapy to improve their spoken language comprehension skills. The therapy sessions include initial assessments, goal setting, progress monitoring, and final goal status determination.