How To Use HCPCS Code G9175

HCPCS code G9175 describes a specific speech language pathology functional limitation and provides information on 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 of patients receiving speech language pathology services.

1. What is HCPCS G9175?

HCPCS code G9175 is a unique alphanumeric code that is used to identify a specific speech language pathology functional limitation. It is part of the Healthcare Common Procedure Coding System (HCPCS) and is used by medical coders and healthcare providers to accurately report and bill for speech language pathology services.

2. Official Description

The official description of HCPCS code G9175 is “Other speech language pathology 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 “Speech lang goal status.”

3. Procedure

1. During the therapy episode outset, the speech language pathologist assesses the patient’s functional limitation and establishes projected goals for therapy.
2. At reporting intervals, the speech language pathologist evaluates the patient’s progress towards the established goals and updates the goal status accordingly.
3. At discharge or to end reporting, the speech language pathologist determines the final goal status based on the patient’s overall progress and outcomes.

4. When to use HCPCS code G9175

HCPCS code G9175 should be used when documenting and reporting the projected goal status of a patient’s speech language pathology functional limitation. It is important to use this code accurately and in the appropriate context to ensure proper billing and reimbursement.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9175, healthcare providers need to document the patient’s functional limitation, the projected goals at therapy episode outset, the progress at reporting intervals, and the final goal status at discharge or to end reporting. This documentation should be detailed and support the medical necessity of the speech language pathology services provided.

6. Historical Information and Code Maintenance

HCPCS code G9175 was added to the Healthcare Common Procedure Coding System on January 1, 2013. It has a coverage code of C, which indicates that carrier judgment is used to determine coverage. The code has an action code of N, which means no maintenance for this code. It is important for medical coders and healthcare providers to stay updated on any changes or revisions to this code.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover speech language pathology services billed with HCPCS code G9175. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the code is not applicable for separate pricing by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9175 should be billed:

1. A patient with a speech language pathology functional limitation related to articulation receives therapy. The speech language pathologist establishes projected goals at the therapy episode outset and updates the goal status at reporting intervals.
2. A patient with a speech language pathology functional limitation related to fluency undergoes therapy. The speech language pathologist assesses the goal status at the therapy episode outset and documents the progress at reporting intervals.
3. A patient with a speech language pathology functional limitation related to voice receives therapy. The speech language pathologist determines the projected goals at the therapy episode outset and evaluates the goal status at discharge or to end reporting.
4. A patient with a speech language pathology functional limitation related to language comprehension undergoes therapy. The speech language pathologist tracks the goal status at the therapy episode outset and updates it at reporting intervals.
5. A patient with a speech language pathology functional limitation related to swallowing receives therapy. The speech language pathologist establishes the projected goals at the therapy episode outset and determines the final goal status at discharge or to end reporting.