How To Use HCPCS Code G9246

HCPCS code G9246 describes a situation where a patient did not have at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits. This code is used to indicate that the patient has not met the requirement for regular medical visits within a specified timeframe.

1. What is HCPCS G9246?

HCPCS code G9246 is used to identify the specific scenario where a patient has not had a medical visit in the designated time period. It is important for medical coders to accurately assign this code to reflect the patient’s lack of compliance with the required medical visits.

2. Official Description

The official description of HCPCS code G9246 is “Patient did not have at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits.” The short description for this code is “No med visit in 24mo.”

3. Procedure

1. Review the patient’s medical records to determine the dates of their medical visits.
2. Calculate the 6 month periods within the 24 month measurement period.
3. Check if there is a minimum of 60 days between each medical visit within the 6 month periods.
4. If the patient did not have at least one medical visit in each 6 month period with a minimum of 60 days between visits, assign HCPCS code G9246.

4. When to use HCPCS code G9246

HCPCS code G9246 should be used when a patient has not met the requirement of having at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits. This code indicates non-compliance with the recommended frequency of medical visits.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9246, healthcare providers should ensure that the patient’s medical records clearly document the dates of their medical visits. The documentation should also indicate the duration of the 6 month periods and the minimum 60-day gap between visits. This information is crucial for accurate coding and billing.

6. Historical Information and Code Maintenance

HCPCS code G9246 was added to the Healthcare Common Procedure Coding System on January 01, 2014. Since its addition, 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 coverage for HCPCS code G9246 may vary. It is important for healthcare providers to check with the respective payers to determine if this code is payable. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value is not established or not applicable as HCPCS is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9246 should be billed:

1. A patient who did not have any medical visits within a 24 month period.
2. A patient who had medical visits, but the visits did not meet the requirement of at least one visit in each 6 month period with a minimum of 60 days between visits.
3. A patient who had medical visits, but the visits were not documented properly, making it impossible to determine if the requirement was met.
4. A patient who had medical visits, but the visits were not within the specified 24 month measurement period.
5. A patient who had medical visits, but the visits were not spaced at least 60 days apart within the 6 month periods.