How To Use HCPCS Code G9265

HCPCS code G9265 describes the provision of maintenance hemodialysis for patients who have been receiving treatment for a period of 90 days or more, with a catheter serving as the mode of vascular access. This code is used to accurately identify and bill for this specific procedure, ensuring proper reimbursement and documentation.

1. What is HCPCS G9265?

HCPCS code G9265 is a specific code used in medical coding to identify the provision of maintenance hemodialysis for patients who have been receiving treatment for 90 days or more, with a catheter as the mode of vascular access. It is important to note that this code is only applicable for patients who meet the specified criteria and have been receiving hemodialysis treatment for an extended period of time.

2. Official Description

The official description of HCPCS code G9265 is “Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access.” This description accurately reflects the specific procedure that this code represents.

3. Procedure

1. The provider prepares the necessary equipment and ensures the cleanliness and sterility of the dialysis machine and supplies.
2. The patient is positioned comfortably in a chair or bed, and the catheter site is cleaned and prepped.
3. A sterile dialysis catheter is inserted into the patient’s blood vessel, typically in the neck or groin area, to establish vascular access.
4. The dialysis machine is connected to the catheter, and the blood is slowly pumped out of the patient’s body, filtered through the machine, and returned back into the body.
5. The process continues for the prescribed duration of the hemodialysis session, typically lasting several hours.
6. Throughout the procedure, the patient’s vital signs and overall well-being are closely monitored by the healthcare team.
7. Once the hemodialysis session is complete, the catheter is carefully removed, and the site is cleaned and dressed appropriately.

4. When to use HCPCS code G9265

HCPCS code G9265 should be used when documenting and billing for maintenance hemodialysis procedures for patients who have been receiving treatment for 90 days or more, and who utilize a catheter as the mode of vascular access. It is important to ensure that the patient meets the specific eligibility criteria for this code before using it for billing purposes.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9265 for billing purposes, healthcare providers should ensure that the necessary documentation is in place to support the provision of maintenance hemodialysis with a catheter as the mode of vascular access for 90 days or more. This may include medical records, progress notes, and any other relevant documentation that demonstrates the medical necessity and appropriateness of the procedure.

6. Historical Information and Code Maintenance

HCPCS code G9265 was added to the Healthcare Common Procedure Coding System on January 1, 2014. It has an effective date of January 1, 2021, and was terminated on December 31, 2020. This code has a pricing indicator code of 00, which indicates that the service is not separately priced by Part B. Additionally, the multiple pricing indicator code is 9, indicating that the value for this code is not established. It is important to stay updated with any changes or revisions to this code to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may provide coverage for HCPCS code G9265, subject to their specific guidelines and policies. It is important to verify coverage and reimbursement rates with the respective payers to ensure proper billing and reimbursement. The carrier judgment coverage code indicates that the determination of coverage for this code is based on the judgment of the carrier or payer.

8. Examples

Here are some examples of scenarios where HCPCS code G9265 may be used:

1. A patient with end-stage renal disease (ESRD) has been receiving maintenance hemodialysis with a catheter for over 90 days. The healthcare provider documents and bills using HCPCS code G9265 to accurately reflect the procedure.
2. A Medicare beneficiary undergoes maintenance hemodialysis with a catheter for an extended period of time. The provider submits a claim using HCPCS code G9265 for reimbursement.
3. A patient with a history of chronic kidney disease requires maintenance hemodialysis with a catheter as the mode of vascular access. The healthcare provider utilizes HCPCS code G9265 for billing purposes.
4. A healthcare facility provides maintenance hemodialysis services to a patient who meets the criteria for HCPCS code G9265. The appropriate documentation is submitted for reimbursement.
5. A patient with a long-standing need for maintenance hemodialysis receives treatment with a catheter as the mode of vascular access. HCPCS code G9265 is used by the healthcare provider for accurate billing and reimbursement.