How To Use HCPCS Code G9248

HCPCS code G9248 describes a specific situation where a patient did not have a medical visit in the last 6 months. This code is used to indicate that the patient has not received any medical care within a certain timeframe, which may have implications for their overall health and well-being. In this article, we will explore the details of HCPCS code G9248, 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 G9248?

HCPCS code G9248 is a specific code that indicates that a patient did not have a medical visit in the last 6 months. It is important to note that this code is not used to bill for any specific procedure or service, but rather to document the absence of medical care within a certain timeframe.

2. Official Description

The official description of HCPCS code G9248 is “Patient did not have a medical visit in the last 6 months.” This description clearly states that the code is used to indicate the absence of a medical visit within the specified timeframe.

3. Procedure

1. There is no specific procedure associated with HCPCS code G9248. Instead, this code is used to document the lack of a medical visit within the last 6 months.

4. When to use HCPCS code G9248

HCPCS code G9248 should be used when a patient has not had a medical visit within the last 6 months. This code is typically used to track and monitor patients who may require regular medical care but have not sought it within the specified timeframe. It is important to accurately document the absence of a medical visit to ensure proper tracking and follow-up.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9248, healthcare providers should ensure that the absence of a medical visit within the last 6 months is clearly documented in the patient’s medical record. This documentation should include the date of the last medical visit and any relevant information regarding the patient’s health status. When billing for services, providers should include HCPCS code G9248 on the claim form to indicate the lack of a medical visit.

6. Historical Information and Code Maintenance

HCPCS code G9248 was added to the Healthcare Common Procedure Coding System on January 1, 2014. It has an effective date of January 1, 2015. This code is classified as a “C” coverage code, which means that carrier judgment is required to determine coverage. The code has a pricing indicator code of 00, indicating that the service is not separately priced by Part B. 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 providers may have specific coverage policies for HCPCS code G9248. It is important to check with the individual payer to determine if this code is payable and how it is priced. The multiple pricing indicator code for this code is 9, indicating that it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9248 should be billed:

1. A patient who has not visited their primary care physician in the last 6 months.
2. A patient who has not received any medical care from any healthcare provider in the last 6 months.
3. A patient who has not had a follow-up visit with a specialist within the last 6 months.
4. A patient who has not had a preventive screening or check-up in the last 6 months.
5. A patient who has not sought medical care despite having a chronic condition that requires regular monitoring.