How To Use HCPCS Code G9245

HCPCS code G9245 describes the prescription of antiretroviral therapy. This code is used to identify the specific treatment plan involving antiviral medications that are prescribed to patients with HIV or AIDS. In this article, we will delve into the details of HCPCS code G9245, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9245?

HCPCS code G9245 is used to indicate the prescription of antiretroviral therapy. Antiretroviral therapy is a treatment regimen that involves the use of antiviral medications to suppress the replication of the human immunodeficiency virus (HIV) in individuals with HIV or acquired immunodeficiency syndrome (AIDS). This therapy plays a crucial role in managing the disease and improving the quality of life for patients.

2. Official Description

The official description of HCPCS code G9245 is “Antiretroviral therapy prescribed.” This description accurately reflects the purpose of this code, which is to identify the prescription of antiretroviral therapy for patients with HIV or AIDS.

3. Procedure

1. The provider evaluates the patient’s medical history, current condition, and laboratory test results to determine the appropriate antiretroviral therapy.
2. Based on the evaluation, the provider selects the specific antiviral medications that will be included in the treatment plan.
3. The provider prescribes the antiretroviral therapy, specifying the dosage, frequency, and duration of treatment.
4. The prescription is documented in the patient’s medical record, including the HCPCS code G9245 to indicate the prescription of antiretroviral therapy.

4. When to use HCPCS code G9245

HCPCS code G9245 should be used when a healthcare provider prescribes antiretroviral therapy to a patient with HIV or AIDS. It is important to note that this code is specific to the prescription of antiretroviral therapy and should not be used for other purposes or treatments.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9245, healthcare providers should ensure that the following documentation requirements are met:

• The prescription of antiretroviral therapy should be clearly documented in the patient’s medical record.
• The medical record should include details of the prescribed medications, including dosage, frequency, and duration of treatment.
• Providers should also include the HCPCS code G9245 on the claim form to indicate the prescription of antiretroviral therapy.

6. Historical Information and Code Maintenance

HCPCS code G9245 was added to the Healthcare Common Procedure Coding System on January 1, 2014. It has a termination date of December 31, 2016. This code is no longer active and should not be used for current claims. It is important for medical coders to stay updated with the latest code changes and ensure the use of active codes for accurate billing and reimbursement.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G9245 may vary. It is essential to check with the specific payer for their coverage policies and guidelines. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare or other insurers. The multiple pricing indicator code is 9, which means that the value for this code is not established. It is crucial to verify the coverage and reimbursement policies to ensure accurate billing.

8. Examples

Here are five examples of scenarios where HCPCS code G9245 should be billed:

1. Example 1: A patient with HIV visits their healthcare provider for a routine check-up. The provider evaluates their condition and prescribes antiretroviral therapy. HCPCS code G9245 should be billed to indicate the prescription of antiretroviral therapy.
2. Example 2: A newly diagnosed patient with AIDS is referred to an infectious disease specialist. The specialist assesses the patient’s condition and prescribes antiretroviral therapy. HCPCS code G9245 should be billed to indicate the prescription of antiretroviral therapy.
3. Example 3: A patient with HIV experiences a change in their viral load, prompting their healthcare provider to modify their antiretroviral therapy. The provider adjusts the prescription and documents the changes in the medical record. HCPCS code G9245 should be billed to indicate the prescription of the modified antiretroviral therapy.
4. Example 4: A pregnant patient with HIV requires antiretroviral therapy to prevent mother-to-child transmission of the virus. The obstetrician prescribes the appropriate antiretroviral medications. HCPCS code G9245 should be billed to indicate the prescription of antiretroviral therapy for the prevention of mother-to-child transmission.
5. Example 5: A patient with HIV undergoes a comprehensive evaluation by an HIV specialist. Based on the evaluation, the specialist prescribes a new antiretroviral therapy regimen tailored to the patient’s specific needs. HCPCS code G9245 should be billed to indicate the prescription of the new antiretroviral therapy regimen.