How To Use HCPCS Code G9165

HCPCS code G9165 describes the attention to functional limitation, current status at therapy episode outset, and at reporting intervals. This code is used to indicate the assessment and monitoring of a patient’s functional limitation at the beginning of a therapy episode and at regular intervals throughout the treatment process.

1. What is HCPCS G9165?

HCPCS code G9165 is a specific code used in medical coding to identify the attention given to a patient’s functional limitation status. It is used to document the assessment and monitoring of a patient’s functional limitation at the beginning of a therapy episode and at reporting intervals during the treatment process.

2. Official Description

The official description of HCPCS code G9165 is “Attention functional limitation, current status at therapy episode outset and at reporting intervals.” The short description for this code is “Atten current status.”

3. Procedure

1. The provider begins by assessing the patient’s functional limitation at the outset of a therapy episode.
2. Throughout the treatment process, the provider continues to monitor and document the patient’s functional limitation status at regular reporting intervals.
3. The assessment and monitoring may involve various tests, measurements, and observations to evaluate the patient’s functional abilities and limitations.
4. The provider records the findings and updates the patient’s functional limitation status in the medical records.

4. When to use HCPCS code G9165

HCPCS code G9165 is used when a healthcare provider needs to document the attention given to a patient’s functional limitation status. It is typically used in therapy settings where the patient’s functional abilities and limitations are assessed and monitored throughout the treatment process.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9165, healthcare providers should ensure that the medical documentation supports the assessment and monitoring of the patient’s functional limitation status. The documentation should include the details of the assessment, any tests or measurements performed, and the findings of the evaluation.

6. Historical Information and Code Maintenance

HCPCS code G9165 was added to the Healthcare Common Procedure Coding System on January 1, 2013. It has an effective date of January 1, 2020, and is no longer maintained as of December 31, 2019. This code is not separately priced by Part B and is considered bundled or not covered by Medicare.

7. Medicare and Insurance Coverage

HCPCS code G9165 is not separately priced by Medicare and is considered bundled or not covered by Part B. The pricing indicator code for this code is 00, which indicates that the service is not separately priced. It is important for healthcare providers to verify coverage and reimbursement policies with Medicare and other insurance carriers.

8. Examples

Here are some examples of when HCPCS code G9165 may be billed:

1. A physical therapist assesses a patient’s functional limitation status at the beginning of a therapy episode and continues to monitor and document the progress at regular reporting intervals.
2. An occupational therapist evaluates a patient’s functional abilities and limitations during the initial assessment and periodically throughout the treatment process.
3. A speech-language pathologist assesses a patient’s functional communication skills and monitors their progress over time.
4. A rehabilitation facility documents the functional limitation status of a patient at the start of their therapy program and tracks their progress throughout the treatment.
5. A chiropractor evaluates a patient’s functional range of motion and monitors any improvements or changes during the course of treatment.