How To Use HCPCS Code G9199

HCPCS code G9199 describes the documentation of reasons why venous thromboembolism (VTE) prophylaxis was not administered on the day of or the day after hospital admission. This code is used to indicate that there were documented reasons for not providing VTE prophylaxis, such as the patient being ambulatory, the patient already being on warfarin or another anticoagulant, the patient expiring during the inpatient stay, or other medical reasons. It is important for medical coders to understand the specific usage and meaning of this code to ensure accurate billing and coding practices.

1. What is HCPCS G9199?

HCPCS code G9199 is used to document the reasons why VTE prophylaxis was not administered on the day of or the day after hospital admission. It is important to note that this code is specific to situations where there are documented reasons for not providing VTE prophylaxis. The code itself does not indicate the administration or non-administration of the prophylaxis, but rather serves as a documentation tool for the reasons behind the decision.

2. Official Description

The official description of HCPCS code G9199 is as follows: “Venous thromboembolism (VTE) prophylaxis not administered the day of or the day after hospital admission for documented reasons (e.g., patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or e.g., patient left against medical advice, other patient reason(s)).” The short description for this code is “Doc reason for no VTE.”

3. Procedure

1. When using HCPCS code G9199, the medical coder should review the patient’s medical records and documentation to determine if there are any documented reasons for not administering VTE prophylaxis on the day of or the day after hospital admission.
2. If there are documented reasons, the medical coder should assign HCPCS code G9199 to indicate the presence of these reasons.
3. The code should be entered accurately and in the appropriate field of the medical claim form.

4. When to use HCPCS code G9199

HCPCS code G9199 should be used when there are documented reasons for not administering VTE prophylaxis on the day of or the day after hospital admission. These reasons may include the patient being ambulatory, the patient already being on warfarin or another anticoagulant, the patient expiring during the inpatient stay, or other medical reasons. It is important to review the patient’s medical records and documentation to ensure accurate usage of this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9199, healthcare providers should ensure that the patient’s medical records and documentation clearly support the reasons for not administering VTE prophylaxis. This documentation should be thorough and specific, providing a clear rationale for the decision. It is important to include any relevant clinical information and supporting documentation to substantiate the use of this code.

6. Historical Information and Code Maintenance

HCPCS code G9199 was terminated on December 31, 2014. This means that it is no longer an active code in the Healthcare Common Procedure Coding System. The termination date indicates that this code is no longer used for billing or coding purposes. It is important for medical coders to be aware of the termination date and to use the appropriate, current codes for documenting VTE prophylaxis.

7. Medicare and Insurance Coverage

Medicare and other insurance coverage for HCPCS code G9199 may vary. It is important for healthcare providers to review the specific guidelines and policies of the payer to determine if this code is payable. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value is not established or the code is not priced separately by Part B. Providers should consult with the payer to understand the reimbursement policies for this code.

8. Examples

Here are five examples of when HCPCS code G9199 should be billed:

1. A patient is admitted to the hospital and is already on warfarin for anticoagulation therapy. VTE prophylaxis is not administered due to the patient’s existing anticoagulant therapy.
2. A patient is admitted to the hospital but is ambulatory and does not meet the criteria for VTE prophylaxis. The documentation supports the decision not to administer prophylaxis.
3. A patient is admitted to the hospital but expires during the inpatient stay. VTE prophylaxis is not administered due to the patient’s death.
4. A patient is admitted to the hospital but leaves against medical advice before VTE prophylaxis can be administered. The documentation supports the decision not to administer prophylaxis.
5. A patient is admitted to the hospital and has other medical reasons documented that contraindicate the administration of VTE prophylaxis. The documentation supports the decision not to administer prophylaxis.