How To Use HCPCS Code G9164

HCPCS code G9164 describes the functional limitation of spoken language expression and the discharge status at the end of therapy or reporting. This code is used to identify the specific circumstances and conditions under which a patient’s ability to express themselves verbally is limited, and to indicate their discharge status at the end of therapy or reporting.

1. What is HCPCS G9164?

HCPCS code G9164 is a specific code used in medical coding to identify the functional limitation of spoken language expression and the discharge status at the end of therapy or reporting. It provides important information about a patient’s ability to communicate verbally and their status at the conclusion of therapy or reporting.

2. Official Description

The official description of HCPCS code G9164 is “Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting.” The short description for this code is “Lang express d/c status.”

3. Procedure

1. During the therapy or reporting period, the healthcare provider assesses the patient’s ability to express themselves verbally.
2. If the patient has a functional limitation in spoken language expression, the provider documents this information.
3. At the end of therapy or reporting, the provider determines the discharge status of the patient.
4. The provider assigns HCPCS code G9164 to indicate the functional limitation of spoken language expression and the discharge status at the end of therapy or reporting.

4. When to use HCPCS code G9164

HCPCS code G9164 is used when a patient has a functional limitation in spoken language expression and their discharge status needs to be documented at the end of therapy or reporting. This code should be used in situations where the patient’s ability to communicate verbally is impaired, and their status at the conclusion of therapy or reporting is relevant for billing and reporting purposes.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9164, healthcare providers need to document the patient’s functional limitation in spoken language expression and their discharge status at the end of therapy or reporting. This documentation should be detailed and include relevant information about the patient’s communication abilities and progress throughout the therapy or reporting period.

6. Historical Information and Code Maintenance

HCPCS code G9164 was added to the Healthcare Common Procedure Coding System on January 1, 2013. It has a coverage code of C, indicating that carrier judgment is used for determining coverage. The code has an action code of N, which means no maintenance is required for this code. The code’s action effective date is January 1, 2020. HCPCS code G9164 is not separately priced by Part B and has a pricing indicator code of 00. The multiple pricing indicator code is 9, indicating that the code is not applicable for separate pricing by Part B.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the services or supplies associated with HCPCS code G9164. However, the pricing for this code is not separately determined by Part B. The coverage and reimbursement for this code may vary depending on the specific policies and guidelines of the insurance provider.

8. Examples

Here are five examples of when HCPCS code G9164 should be billed:

1. A patient undergoes speech therapy to improve their spoken language expression. At the end of therapy, it is determined that the patient’s functional limitation in spoken language expression has improved, and they are discharged with a status indicating successful completion of therapy.
2. A patient with a neurological condition experiences a decline in their ability to express themselves verbally. Throughout the therapy period, their progress is monitored, and at the end of therapy, their discharge status reflects their ongoing functional limitation in spoken language expression.
3. A patient receives therapy for a temporary condition that affects their ability to communicate verbally. At the end of therapy, their discharge status indicates that their spoken language expression has returned to normal, and they no longer have a functional limitation.
4. A patient with a developmental delay undergoes therapy to improve their spoken language expression. At the end of therapy, their discharge status reflects their progress and ongoing functional limitation in spoken language expression.
5. A patient receives therapy for a specific communication disorder that affects their spoken language expression. At the end of therapy, their discharge status indicates the level of improvement achieved and any ongoing functional limitation.