How To Use HCPCS Code G9314

HCPCS code G9314 describes the use of amoxicillin, with or without clavulanate, when it is not prescribed as the first line antibiotic at the time of diagnosis and the reason for this decision is not given. This code falls under the category of medical care and is not separately priced by Part B of Medicare. In this article, we will explore the details of HCPCS code G9314, 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 G9314?

HCPCS code G9314 is used to identify the use of amoxicillin, with or without clavulanate, when it is not prescribed as the first line antibiotic at the time of diagnosis and the reason for this decision is not given. This code is used to capture specific instances where amoxicillin is not the initial choice of antibiotic treatment for a patient, but is still prescribed for their condition.

2. Official Description

The official description of HCPCS code G9314 is “Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given.” The short description for this code is “Norsn not first line amox.”

3. Procedure

1. The healthcare provider evaluates the patient’s condition and determines that amoxicillin, with or without clavulanate, is necessary for treatment.
2. The provider documents the reason for not prescribing amoxicillin as the first line antibiotic at the time of diagnosis.
3. The provider prescribes the appropriate dosage and duration of amoxicillin, with or without clavulanate, based on the patient’s condition.
4. The prescription is filled by the patient at a pharmacy.
5. The patient takes the prescribed medication as directed by the healthcare provider.

4. When to use HCPCS code G9314

HCPCS code G9314 should be used when a healthcare provider prescribes amoxicillin, with or without clavulanate, for a patient, but it is not the first line antibiotic recommended at the time of diagnosis. The reason for this decision is not given, but it is important for the provider to document the rationale behind this choice in the patient’s medical record.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9314, healthcare providers should ensure that the reason for not prescribing amoxicillin as the first line antibiotic is clearly documented in the patient’s medical record. This documentation is essential for accurate coding and billing purposes. Additionally, providers should follow the standard billing guidelines and requirements set forth by Medicare or other insurance carriers.

6. Historical Information and Code Maintenance

HCPCS code G9314 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. This code falls under the category of medical care and is not separately priced by Part B of Medicare.

7. Medicare and Insurance Coverage

HCPCS code G9314 is covered by Medicare, but it is not separately priced by Part B. 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, which indicates that the value for this code is not established. This means that the service is either not priced separately by Part B or the pricing indicator is ’99’. It is important for healthcare providers to understand the specific coverage and pricing guidelines set forth by Medicare or other insurance carriers.

8. Examples

Here are five examples of when HCPCS code G9314 should be billed:

1. A patient presents with a urinary tract infection and has a history of allergies to other antibiotics. The healthcare provider prescribes amoxicillin, with or without clavulanate, as an alternative treatment option.
2. A patient is diagnosed with a skin infection and has previously been treated with amoxicillin without success. The healthcare provider prescribes amoxicillin, with or without clavulanate, as a second-line antibiotic.
3. A patient is diagnosed with a respiratory infection and has a history of non-compliance with antibiotic treatment. The healthcare provider prescribes amoxicillin, with or without clavulanate, due to its effectiveness and the patient’s familiarity with the medication.
4. A patient presents with a dental abscess and has a known penicillin allergy. The healthcare provider prescribes amoxicillin, with or without clavulanate, as an alternative antibiotic option.
5. A patient is diagnosed with a sinus infection and has previously been treated with other antibiotics without success. The healthcare provider prescribes amoxicillin, with or without clavulanate, as a second-line treatment option.