How To Use HCPCS Code G9211

HCPCS code G9211 describes the absence of hepatitis C quantitative RNA testing between 4-12 weeks after the initiation of antiviral treatment, without a documented reason. This code is used to indicate that the necessary testing was not performed during the specified timeframe, and the reason for not conducting the test was not provided.

1. What is HCPCS G9211?

HCPCS code G9211 is a specific code used in medical coding to identify the absence of hepatitis C quantitative RNA testing between 4-12 weeks after the initiation of antiviral treatment, without a documented reason. It is important to accurately assign this code to reflect the lack of testing during the specified timeframe.

2. Official Description

The official description of HCPCS code G9211 is “Hepatitis C quantitative RNA testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given.” The short description for this code is “No hepc rna after med no rsn.”

3. Procedure

1. The healthcare provider should review the patient’s medical records to determine if hepatitis C quantitative RNA testing was performed.
2. If the testing was not conducted between 4-12 weeks after the initiation of antiviral treatment, the provider should document the absence of the test.
3. If the reason for not performing the test is not provided in the medical records, the provider should indicate that the reason was not documented.

4. When to use HCPCS code G9211

HCPCS code G9211 should be used when the healthcare provider did not perform hepatitis C quantitative RNA testing between 4-12 weeks after the initiation of antiviral treatment, and there is no documented reason for not conducting the test. It is important to accurately assign this code to reflect the absence of testing during the specified timeframe.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9211, healthcare providers need to document the absence of hepatitis C quantitative RNA testing between 4-12 weeks after the initiation of antiviral treatment. The medical records should clearly indicate that the necessary testing was not performed, and if the reason for not conducting the test is not provided, it should be documented as “reason not given.”

6. Historical Information and Code Maintenance

HCPCS code G9211 was added to the Healthcare Common Procedure Coding System on January 1, 2014. It has a termination date of December 31, 2016. This code has no maintenance actions, as indicated by the action code N, which means no maintenance for this code. It is important to note that this code is no longer active and should not be used for current billing purposes.

7. Medicare and Insurance Coverage

HCPCS code G9211 is not separately priced by Medicare or other insurers. It falls under the pricing indicator code 00, which means the service is not separately priced by Part B. This code is not covered or reimbursed as a standalone service and may be bundled with other services or not covered at all. Healthcare providers should review the specific guidelines and policies of the insurance plans they work with to determine coverage and reimbursement for this code.

8. Examples

Here are five examples of scenarios where HCPCS code G9211 may be used:

1. A patient with hepatitis C undergoes antiviral treatment, but the healthcare provider does not perform the required quantitative RNA testing between 4-12 weeks after treatment initiation, and no reason is documented.
2. A healthcare provider prescribes antiviral treatment for a patient with hepatitis C, but the necessary quantitative RNA testing is not conducted within the specified timeframe, and no reason is provided in the medical records.
3. During a follow-up visit after antiviral treatment for hepatitis C, the healthcare provider fails to perform the required quantitative RNA testing between 4-12 weeks, and no documented reason is available.
4. A patient with hepatitis C receives antiviral treatment, but the healthcare provider does not conduct the necessary quantitative RNA testing within the recommended timeframe, and no reason for not performing the test is documented.
5. After initiating antiviral treatment for hepatitis C, the healthcare provider does not perform the required quantitative RNA testing between 4-12 weeks, and no reason is provided in the patient’s medical records.