How To Use HCPCS Code G9264

HCPCS code G9264 describes the documentation of a patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons. This code is used to indicate that the patient has been undergoing hemodialysis treatment for an extended period of time and has been using a catheter for access.

1. What is HCPCS G9264?

HCPCS code G9264 is a specific code used in medical coding to identify and document the provision of maintenance hemodialysis for a patient who has been receiving treatment for 90 days or more and is using a catheter for access. This code is used to accurately represent the specific circumstances of the patient’s treatment and is important for proper billing and reimbursement.

2. Official Description

The official description of HCPCS code G9264 is “Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., other medical reasons, patient declined arteriovenous fistula (avf)/arteriovenous graft (avg), other patient reasons)”. The short description of this code is “Doc rsn hemod w/cath >=90d”. These descriptions provide a clear understanding of the purpose and usage of this code.

3. Procedure

1. The healthcare provider should ensure that the patient has been receiving maintenance hemodialysis treatment for a minimum of 90 days.
2. The provider should document the reasons for the patient’s use of a catheter for hemodialysis access. This may include other medical reasons, the patient’s refusal or inability to undergo arteriovenous fistula (avf) or arteriovenous graft (avg) placement, or other patient-specific reasons.
3. The documentation should clearly indicate that the patient has been receiving ongoing hemodialysis treatment and has been using a catheter for access for the specified duration.
4. All relevant information, including the patient’s medical history, any complications or issues related to the catheter, and any changes in the treatment plan, should be accurately documented.

4. When to use HCPCS code G9264

HCPCS code G9264 should be used when documenting a patient who has been receiving maintenance hemodialysis treatment for 90 days or more and is using a catheter for access. It is important to use this code when the specific circumstances described in the official description are met. This code should not be used for patients who have not met the minimum duration requirement or for patients who are not using a catheter for access.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9264, healthcare providers should ensure that all necessary documentation is in place to support the use of this code. This may include:

• Medical records indicating the patient’s ongoing maintenance hemodialysis treatment for 90 days or more
• Documentation of the reasons for the patient’s use of a catheter for hemodialysis access
• Any relevant diagnostic tests or imaging studies
• Documentation of any complications or issues related to the catheter

By providing comprehensive and accurate documentation, healthcare providers can ensure proper billing and reimbursement for the services rendered.

6. Historical Information and Code Maintenance

HCPCS code G9264 was added to the Healthcare Common Procedure Coding System on January 1, 2014. It has an effective date of January 1, 2021. As of December 31, 2020, this code has been terminated. The termination of a code means that it is no longer valid for use in medical coding and billing.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may have specific coverage guidelines and policies regarding HCPCS code G9264. It is important for healthcare providers to familiarize themselves with these guidelines to ensure proper reimbursement. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the code is not applicable for separate pricing by Part B or the value is not established.

8. Examples

Here are some examples of when HCPCS code G9264 should be billed:

1. A patient has been receiving maintenance hemodialysis treatment for 120 days and is using a catheter for access due to other medical reasons.
2. A patient has been undergoing hemodialysis for 100 days and has declined arteriovenous fistula (avf) or arteriovenous graft (avg) placement, opting to continue using a catheter for access.
3. A patient has been receiving maintenance hemodialysis treatment for 90 days and is using a catheter for access due to personal reasons.
4. A patient has been undergoing hemodialysis for 150 days and is using a catheter for access due to complications with previous arteriovenous fistula (avf) placement.
5. A patient has been receiving maintenance hemodialysis treatment for 180 days and is using a catheter for access due to other documented reasons.