How To Use HCPCS Code G9363

HCPCS code G9363 describes the duration of monitored anesthesia care (MAC) or peripheral nerve block (PNB) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record.

1. What is HCPCS G9363?

HCPCS code G9363 is used to identify the duration of monitored anesthesia care (MAC) or peripheral nerve block (PNB) without the use of general anesthesia during a procedure, or general or neuraxial anesthesia that lasts less than 60 minutes. This code is documented in the anesthesia record and is used to accurately report the duration of anesthesia services provided.

2. Official Description

The official description of HCPCS code G9363 is “Duration of monitored anesthesia care (MAC) or peripheral nerve block (PNB) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record.” The short description for this code is “MAC or PNB without genanes <60m."

3. Procedure

1. The provider administers monitored anesthesia care (MAC) or performs a peripheral nerve block (PNB) without the use of general anesthesia.
2. The duration of the MAC or PNB is documented in the anesthesia record.
3. If the duration of the MAC or PNB is less than 60 minutes, HCPCS code G9363 is used to report the service.

4. When to use HCPCS code G9363

HCPCS code G9363 should be used when the provider administers monitored anesthesia care (MAC) or performs a peripheral nerve block (PNB) without the use of general anesthesia during an applicable procedure, or when the duration of general or neuraxial anesthesia is less than 60 minutes. It is important to accurately document the duration of the MAC or PNB in the anesthesia record to support the use of this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9363, healthcare providers should ensure that the anesthesia record clearly documents the duration of the monitored anesthesia care (MAC) or peripheral nerve block (PNB) without the use of general anesthesia. This documentation should include the start and end times of the anesthesia service. It is important to accurately report the duration of the service to support proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9363 was added to the Healthcare Common Procedure Coding System on January 1, 2015. It has a termination date of December 31, 2015. No maintenance actions have been taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders to be aware of the historical context and termination date of this code to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

HCPCS code G9363 is covered by Medicare and other insurance providers. 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 be bundled or not covered by Medicare. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS G9363 is not priced separately by Part B or the value is not established. It is important for healthcare providers to review the specific coverage policies of Medicare and other insurance providers to determine the reimbursement for this service.

8. Examples

Here are five examples of when HCPCS code G9363 should be billed:

1. A patient undergoes a surgical procedure under monitored anesthesia care (MAC) for 45 minutes. HCPCS code G9363 should be used to report the duration of the MAC.
2. A patient receives a peripheral nerve block (PNB) for pain management during a procedure that lasts 30 minutes. HCPCS code G9363 should be used to report the duration of the PNB.
3. A patient undergoes a surgical procedure under general anesthesia for 90 minutes, but the duration of the monitored anesthesia care (MAC) without the use of general anesthesia is 50 minutes. HCPCS code G9363 should be used to report the duration of the MAC.
4. A patient receives a peripheral nerve block (PNB) for pain management during a procedure that lasts 20 minutes. HCPCS code G9363 should be used to report the duration of the PNB.
5. A patient undergoes a surgical procedure under general anesthesia for 45 minutes, but the duration of the monitored anesthesia care (MAC) without the use of general anesthesia is 30 minutes. HCPCS code G9363 should be used to report the duration of the MAC.