How To Use HCPCS Code G9358

HCPCS code G9358 describes post-partum screenings, evaluations, and education that were not performed. This code is used to indicate that the healthcare provider did not conduct the necessary assessments and educational sessions for a patient who has recently given birth. In this article, we will explore the details of HCPCS code G9358, 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 G9358?

HCPCS code G9358 is used to identify the absence of post-partum screenings, evaluations, and education that should have been performed for a patient. It indicates that the healthcare provider did not conduct the necessary assessments and educational sessions for a patient who has recently given birth. This code is specific to post-partum care and is not applicable to other medical conditions or procedures.

2. Official Description

The official description of HCPCS code G9358 is “Post-partum screenings, evaluations, and education not performed.” The short description is “Pp eval/edu not perf.” This description clearly indicates that the healthcare provider did not perform the required post-partum screenings, evaluations, and education for the patient.

3. Procedure

1. The healthcare provider should have conducted post-partum screenings to assess the physical and emotional well-being of the patient after childbirth.
2. Evaluations should have been performed to identify any potential complications or issues that may arise during the post-partum period.
3. Education sessions should have been provided to the patient to educate them about post-partum care, including breastfeeding, self-care, and warning signs of complications.
4. However, in the case of HCPCS code G9358, these screenings, evaluations, and education were not performed by the healthcare provider.

4. When to use HCPCS code G9358

HCPCS code G9358 should be used when the healthcare provider did not perform the necessary post-partum screenings, evaluations, and education for a patient who has recently given birth. This code indicates that the required care was not provided, and the patient may need to seek alternative sources for post-partum support and education.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9358, healthcare providers should clearly document the reasons why the post-partum screenings, evaluations, and education were not performed. This documentation should include any relevant medical or personal factors that contributed to the omission of these services. It is important to accurately reflect the circumstances surrounding the lack of care in the patient’s medical records to ensure proper billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9358 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. The code has remained unchanged since its inception.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G9358 may vary. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This indicates that the service may not be covered or may be bundled with other services. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS code G9358 is not priced separately by Part B. It is important to check with Medicare and individual insurance providers to determine coverage and reimbursement for this code.

8. Examples

Here are five examples of when HCPCS code G9358 should be billed:

1. A healthcare provider fails to conduct the required post-partum screenings for a patient who has recently given birth.
2. The healthcare provider does not perform the necessary evaluations to identify any potential complications or issues during the post-partum period.
3. The patient does not receive the expected education sessions on post-partum care, breastfeeding, self-care, and warning signs of complications.
4. The healthcare provider neglects to provide any post-partum support or guidance to the patient.
5. The patient seeks post-partum care from another healthcare provider due to the lack of screenings, evaluations, and education provided by the initial healthcare provider.