How To Use HCPCS Code G9186

HCPCS code G9186 describes motor speech functional limitation and the projected goal status at therapy episode outset, reporting intervals, and discharge or to end reporting. This code is used to identify the assessment and monitoring of motor speech goals during therapy sessions.

1. What is HCPCS G9186?

HCPCS code G9186 is a specific code used in medical coding to identify motor speech functional limitation and the projected goal status at therapy episode outset, reporting intervals, and discharge or to end reporting. It provides a standardized way to document and track the progress of motor speech therapy goals for patients.

2. Official Description

The official description of HCPCS code G9186 is “Motor speech 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 “Motor speech goal status.”

3. Procedure

1. The provider begins by assessing the motor speech 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 of the patient’s motor speech.
3. At reporting intervals, the provider updates the goal status based on the progress made by the patient.
4. Finally, at discharge or the end of reporting, the provider records the final goal status achieved by the patient.

4. When to use HCPCS code G9186

HCPCS code G9186 should be used when documenting and reporting the motor speech functional limitation and the projected goal status at therapy episode outset, reporting intervals, and discharge or to end reporting. It is typically used by speech-language pathologists or other healthcare professionals involved in motor speech therapy.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9186, healthcare providers need to document the assessment of motor speech functional limitation, the projected goal status at therapy episode outset, reporting intervals, and discharge or to end reporting. This documentation should be detailed and include specific information about the patient’s motor speech goals and progress made during therapy sessions.

6. Historical Information and Code Maintenance

HCPCS code G9186 was added to the Healthcare Common Procedure Coding System on January 1, 2013. It has a coverage code of C, which indicates that coverage is determined by carrier judgment. The code has an action code of N, meaning no maintenance is required for this code. It was terminated on December 31, 2019.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the assessment and monitoring of motor speech goals using HCPCS code G9186. However, the pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This could indicate that the service may be bundled or not covered by Medicare or other insurers. It is important to check with the specific insurance provider for coverage and reimbursement details.

8. Examples

Here are five examples of when HCPCS code G9186 should be billed:

1. A patient with a motor speech impairment undergoes an initial assessment to determine the functional limitation and establish therapy goals. The provider documents the goal status at therapy episode outset using HCPCS code G9186.
2. During the therapy sessions, the provider regularly evaluates the patient’s progress and updates the goal status accordingly. Each update is reported using HCPCS code G9186.
3. At reporting intervals, the provider reviews the patient’s motor speech goals and documents any changes or improvements. The updated goal status is reported using HCPCS code G9186.
4. As the therapy progresses, the patient achieves significant improvement in motor speech. The provider records the final goal status at discharge or the end of reporting using HCPCS code G9186.
5. In a follow-up session after the therapy, the provider reassesses the patient’s motor speech functional limitation and documents the goal status at the follow-up visit using HCPCS code G9186.