How To Use HCPCS Code G9172

HCPCS code G9172 describes the projected goal status of voice functional limitation at the therapy episode outset, at reporting intervals, and at discharge or to end reporting. This code is used to track the progress and outcomes of voice therapy for patients with voice-related functional limitations. In this article, we will explore the details of HCPCS code G9172, 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 G9172?

HCPCS code G9172 is a unique code used in medical coding to identify the projected goal status of voice functional limitation at various stages of therapy. It provides information on the progress and outcomes of voice therapy for patients with voice-related functional limitations. This code is essential for tracking and documenting the effectiveness of voice therapy interventions.

2. Official Description

The official description of HCPCS code G9172 is “Voice 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 “Voice goal status.”

3. Procedure

1. The provider assesses the voice functional limitation of the patient at the beginning of the therapy episode.
2. Throughout the therapy, the provider periodically evaluates the progress and updates the projected goal status of the voice functional limitation.
3. At the end of the therapy episode or reporting period, the provider determines the final goal status of the voice functional limitation.
4. All assessments and updates are documented in the patient’s medical records.

4. When to use HCPCS code G9172

HCPCS code G9172 should be used when reporting the projected goal status of voice functional limitation at the therapy episode outset, at reporting intervals, and at discharge or to end reporting. It is important to use this code accurately and consistently to track the progress and outcomes of voice therapy interventions.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9172, healthcare providers need to document the following:

• The initial assessment of the voice functional limitation at the therapy episode outset.
• Updates on the projected goal status of the voice functional limitation at reporting intervals.
• The final goal status of the voice functional limitation at discharge or to end reporting.

Accurate and detailed documentation is crucial for proper billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9172 was added to the Healthcare Common Procedure Coding System on January 1, 2013. It has an effective date of January 1, 2020. This code does not have any maintenance actions, as indicated by the action code N, which means 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 coverage for HCPCS code G9172 is determined by the carrier judgment, indicated by the coverage code C. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. It is important to check with individual insurance providers regarding coverage and reimbursement policies for this code.

8. Examples

Here are five examples of when HCPCS code G9172 should be billed:

1. A patient with a voice functional limitation undergoes voice therapy. The initial assessment indicates a moderate limitation. Throughout the therapy, the projected goal status is updated to reflect improvement. At discharge, the final goal status is determined to be minimal limitation.
2. A patient with a voice functional limitation starts voice therapy. The initial assessment reveals a severe limitation. Despite therapy interventions, the projected goal status remains unchanged throughout the reporting intervals. At discharge, the final goal status remains severe limitation.
3. A patient with a voice functional limitation begins voice therapy. The initial assessment shows a mild limitation. The projected goal status is consistently updated to reflect significant improvement during the reporting intervals. At discharge, the final goal status is determined to be no limitation.
4. A patient with a voice functional limitation receives voice therapy. The initial assessment indicates a moderate limitation. Throughout the therapy, the projected goal status fluctuates between mild and moderate limitation. At discharge, the final goal status is determined to be moderate limitation.
5. A patient with a voice functional limitation starts voice therapy. The initial assessment reveals a minimal limitation. Despite therapy interventions, the projected goal status remains unchanged throughout the reporting intervals. At discharge, the final goal status remains minimal limitation.