How To Use HCPCS Code G9361

HCPCS code G9361 describes the medical indication for delivery by cesarean birth or induction of labor before 39 weeks of gestation. This code is used to document the reasons for elective delivery, such as hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in a clinical trial.

1. What is HCPCS G9361?

HCPCS code G9361 is a specific code used in medical coding to identify the medical indication for delivery by cesarean birth or induction of labor before 39 weeks of gestation. It is important to accurately assign this code to ensure proper documentation and billing for the services provided.

2. Official Description

The official description of HCPCS code G9361 is “Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)]." The short description for this code is "Doc rsn elect c-sec/induct."

3. Procedure

1. The procedure for HCPCS code G9361 involves the medical indication for delivery by cesarean birth or induction of labor before 39 weeks of gestation.
2. The healthcare provider must document the specific reasons for the elective delivery, which may include hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in a clinical trial.
3. The documentation should clearly state the medical necessity for the elective delivery and provide supporting evidence or medical records.

4. When to use HCPCS code G9361

HCPCS code G9361 should be used when there is a medical indication for delivery by cesarean birth or induction of labor before 39 weeks of gestation. It is important to document the specific reasons for the elective delivery, as outlined in the official description of the code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9361, healthcare providers need to ensure that the medical indication for the elective delivery is clearly documented in the patient’s medical records. The documentation should include the specific reasons for the elective delivery, such as hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in a clinical trial.

6. Historical Information and Code Maintenance

HCPCS code G9361 was added to the Healthcare Common Procedure Coding System on January 01, 2014. As of January 01, 2022, 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 G9361. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which indicates that the code is not applicable for separate pricing by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9361 should be billed:

1. A pregnant patient with preeclampsia at 38 weeks of gestation requires an elective cesarean delivery due to the potential risks to both the mother and the baby.
2. A patient with a history of prior uterine surgery is scheduled for an elective induction of labor at 37 weeks of gestation to avoid potential complications during a vaginal delivery.
3. A pregnant patient with hypertension and placental complications is recommended to undergo an elective cesarean delivery at 36 weeks of gestation to minimize the risks to both the mother and the baby.
4. A patient participating in a clinical trial for the management of late pregnancy complications is scheduled for an elective induction of labor at 38 weeks of gestation.
5. A pregnant patient with a fetal condition complicating pregnancy/delivery is recommended to undergo an elective cesarean delivery at 39 weeks of gestation to ensure the best possible outcome for the baby.