How To Use HCPCS Code G9169

HCPCS code G9169 describes the projected goal status of memory functional limitation at the therapy episode outset, reporting intervals, and discharge or to end reporting. This code is used to track the progress and improvement of memory function during therapy sessions.

1. What is HCPCS G9169?

HCPCS code G9169 is a specific code used in medical coding to identify the projected goal status of memory functional limitation. It provides information on the expected outcome of therapy sessions related to memory function. This code is essential for accurately documenting and tracking the progress of patients with memory impairments.

2. Official Description

The official description of HCPCS code G9169 is “Memory 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 “Memory goal status.”

3. Procedure

1. The provider assesses the memory functional limitation of the patient at the beginning of the therapy episode.
2. Throughout the therapy sessions, the provider periodically evaluates and documents the progress of the patient’s memory function.
3. At the end of the therapy episode or reporting period, the provider determines the final goal status of the patient’s memory function.

4. When to use HCPCS code G9169

HCPCS code G9169 should be used when documenting and reporting the projected goal status of memory functional limitation for patients undergoing therapy. It is important to use this code accurately to provide a comprehensive overview of the patient’s progress in memory function improvement.

5. Billing Guidelines and Documentation Requirements

When billing for services related to HCPCS code G9169, healthcare providers need to ensure proper documentation of the patient’s memory functional limitation, the projected goal status at the therapy episode outset, reporting intervals, and at discharge or to end reporting. This documentation should be detailed and support the medical necessity of the therapy sessions.

6. Historical Information and Code Maintenance

HCPCS code G9169 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. It is important to note that this code was terminated on December 31, 2019.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover services related to HCPCS code G9169. However, it is essential to check with the specific payer for their coverage policies and guidelines. The pricing indicator code for this code is 00, indicating that the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value is not established or applicable for separate pricing.

8. Examples

Here are five examples of when HCPCS code G9169 should be billed:

1. A patient with memory impairment undergoes therapy sessions to improve memory function. The provider assesses the goal status at the therapy episode outset, at reporting intervals, and at discharge.
2. A therapist works with a patient with memory limitations to set goals for memory improvement. The provider documents the progress and final goal status using HCPCS code G9169.
3. During therapy sessions, the provider evaluates the memory function of a patient with a cognitive impairment. The goal status is updated at reporting intervals and at the end of the therapy episode.
4. A patient with memory functional limitation receives therapy sessions to enhance memory skills. The provider tracks the goal status throughout the treatment period using HCPCS code G9169.
5. After a series of therapy sessions focused on memory improvement, the provider determines the final goal status of the patient’s memory function using HCPCS code G9169.