How To Use HCPCS Code G9231

HCPCS code G9231 describes the documentation of end stage renal disease (ESRD), dialysis, renal transplant before or during the measurement period, or pregnancy during the measurement period. This code is used to indicate specific circumstances related to the patient’s medical condition during the measurement period.

1. What is HCPCS G9231?

HCPCS code G9231 is a specific code used in medical coding to identify and document certain conditions or procedures related to end stage renal disease, dialysis, renal transplant, or pregnancy during the measurement period. It provides a standardized way of communicating this information between healthcare providers, insurance companies, and other entities involved in the healthcare system.

2. Official Description

The official description of HCPCS code G9231 is “Documentation of end stage renal disease (ESRD), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period.” The short description for this code is “Doc esrd dia trans preg.”

3. Procedure

1. During the measurement period, the healthcare provider should thoroughly document any instances of end stage renal disease, dialysis, renal transplant, or pregnancy that are relevant to the patient’s medical condition.
2. The documentation should include details such as the date of diagnosis, the type of treatment or procedure performed, and any other pertinent information.
3. It is important for the healthcare provider to accurately record this information in the patient’s medical records to ensure proper coding and billing.

4. When to use HCPCS code G9231

HCPCS code G9231 should be used when documenting end stage renal disease, dialysis, renal transplant, or pregnancy during the measurement period. It is important to use this code only when the specific circumstances described in the official description are present.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies related to HCPCS code G9231, healthcare providers need to ensure that the documentation supports the use of this code. They should include all relevant information in the patient’s medical records, such as the diagnosis, treatment, and any other pertinent details.

6. Historical Information and Code Maintenance

HCPCS code G9231 was added to the Healthcare Common Procedure Coding System on January 01, 2014. As of January 01, 2017, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare and other insurance companies may provide coverage for services or supplies related to HCPCS code G9231. 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, which indicates that the value is not established or the code is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9231 should be billed:

1. A patient with end stage renal disease undergoes dialysis three times a week during the measurement period.
2. A patient receives a renal transplant before the measurement period and requires ongoing monitoring and follow-up visits.
3. A pregnant patient receives prenatal care and monitoring during the measurement period.
4. A patient with end stage renal disease undergoes dialysis and subsequently receives a renal transplant during the measurement period.
5. A pregnant patient with end stage renal disease undergoes dialysis and requires specialized care during the measurement period.