How To Use HCPCS Code G9296

HCPCS code G9296 describes the documentation of shared decision-making between a healthcare provider and a patient, specifically regarding the discussion of conservative (non-surgical) therapy options prior to a procedure. This code is used to indicate that the patient has been informed about and considered alternative treatment options, such as NSAIDs, analgesics, weight loss, exercise, and injections, before proceeding with a surgical intervention.

1. What is HCPCS G9296?

HCPCS code G9296 is a specific code used in medical coding to identify and document the shared decision-making process between a healthcare provider and a patient. It signifies that the patient has been informed about conservative therapy options and has participated in a discussion regarding these alternatives before undergoing a procedure.

2. Official Description

The official description of HCPCS code G9296 is “Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., NSAIDs, analgesics, weight loss, exercise, injections) prior to the procedure.” The short description for this code is “Doc share dec prior proc.”

3. Procedure

1. The healthcare provider initiates a conversation with the patient regarding the planned procedure.
2. The provider discusses the various conservative therapy options available to the patient, such as NSAIDs, analgesics, weight loss, exercise, and injections.
3. The provider documents the shared decision-making process, including the discussion of conservative therapy, in the patient’s medical record.
4. If the patient decides to proceed with the procedure after considering the conservative therapy options, the provider notes this decision in the medical record as well.

4. When to use HCPCS code G9296

HCPCS code G9296 should be used when a healthcare provider has engaged in shared decision-making with a patient and has discussed conservative therapy options prior to a procedure. This code is applicable when the patient has been informed about the potential benefits and risks of conservative therapy and has actively participated in the decision-making process.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9296, healthcare providers should ensure that the shared decision-making process and the discussion of conservative therapy options are clearly documented in the patient’s medical record. This documentation should include details of the conversation, the alternatives discussed, and the patient’s decision to proceed with the procedure. Proper documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9296 was added to the Healthcare Common Procedure Coding System on January 1, 2014. It has an effective date of January 1, 2015. As of now, 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 cover the services associated with HCPCS code G9296, but the coverage may vary depending on the specific policies and guidelines of each insurer. It is important for healthcare providers to verify the coverage and reimbursement policies of the respective insurance companies before submitting claims.

8. Examples

Here are five examples of scenarios where HCPCS code G9296 would be appropriate:

1. A patient with chronic knee pain visits an orthopedic surgeon. The surgeon discusses the various non-surgical treatment options, such as NSAIDs, weight loss, and physical therapy, before recommending knee replacement surgery. The shared decision-making process is documented, and the patient decides to proceed with the surgery.
2. A patient with lower back pain consults a pain management specialist. The specialist explains the different conservative therapy options, including analgesics, exercise, and injections, before suggesting a minimally invasive procedure. The patient actively participates in the decision-making process and agrees to undergo the procedure.
3. A patient with shoulder impingement syndrome sees a physical therapist. The therapist discusses the benefits of exercise, NSAIDs, and corticosteroid injections as conservative treatment options. After considering these alternatives, the patient decides to proceed with arthroscopic surgery. The shared decision-making process is documented in the medical record.
4. A patient with osteoarthritis in the hip visits an orthopedic surgeon. The surgeon explains the potential benefits and risks of weight loss, NSAIDs, and physical therapy as non-surgical treatment options. The patient decides to undergo total hip replacement surgery after considering these alternatives. The shared decision-making process is documented in the medical record.
5. A patient with chronic migraines consults a neurologist. The neurologist discusses the various conservative therapy options, such as lifestyle modifications, analgesics, and preventive medications, before recommending a nerve block procedure. The patient actively participates in the decision-making process and agrees to undergo the procedure.