How To Use HCPCS Code G9166

HCPCS code G9166 describes the attention to functional limitation and the projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting. This code is used to track and document the progress and outcomes of therapy sessions for patients with functional limitations. In this article, we will explore the details of HCPCS code G9166, 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 G9166?

HCPCS code G9166 is a specific code used in medical coding to identify the attention given to functional limitation and the projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting. It is an important code that helps healthcare providers track and document the progress and outcomes of therapy sessions for patients with functional limitations.

2. Official Description

The official description of HCPCS code G9166 is “Attention 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 “Atten goal status.”

3. Procedure

1. The provider begins by assessing the functional limitation of the patient at the therapy episode outset.
2. Throughout the therapy sessions, the provider periodically evaluates and documents the projected goal status.
3. At reporting intervals, the provider updates the goal status based on the progress made by the patient.
4. Finally, at discharge or to end reporting, the provider assesses the overall goal status achieved by the patient.

4. When to use HCPCS code G9166

HCPCS code G9166 should be used when healthcare providers need to track and document the attention given to functional limitation and the projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting. This code is specifically used for patients undergoing therapy sessions for functional limitations.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9166, healthcare providers need to ensure proper documentation of the attention given to functional limitation and the projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting. This documentation should include detailed notes on the patient’s functional limitations, the goals set at the beginning of therapy, progress made during therapy sessions, and the overall goal status achieved at the end of therapy.

6. Historical Information and Code Maintenance

HCPCS code G9166 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 does not have any maintenance actions, as indicated by the action code N, meaning no maintenance for this code. It is important to note that this code was terminated on December 31, 2019.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G9166 may vary. 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 essential for healthcare providers to check with Medicare and other insurers to determine the coverage and reimbursement policies for this code.

8. Examples

Here are five examples of when HCPCS code G9166 should be billed:

1. A patient with a functional limitation in mobility undergoes physical therapy sessions. The therapist assesses the goal status at the beginning, tracks the progress throughout the sessions, and evaluates the achieved goal status at the end.
2. A patient with a functional limitation in speech undergoes speech therapy sessions. The therapist documents the goal status at the therapy episode outset, updates it at reporting intervals, and assesses the final goal status at discharge.
3. A patient with a functional limitation in fine motor skills receives occupational therapy sessions. The therapist monitors the goal status at each reporting interval and documents the overall goal status achieved at the end of therapy.
4. A patient with a functional limitation in cognition undergoes cognitive therapy sessions. The therapist evaluates the projected goal status at the therapy episode outset, tracks the progress during reporting intervals, and assesses the goal status at discharge.
5. A patient with a functional limitation in balance and coordination undergoes physical therapy sessions. The therapist documents the goal status at the beginning, updates it at reporting intervals, and assesses the achieved goal status at the end of therapy.