How To Use HCPCS Code G9369

HCPCS code G9369 describes an individual who has filled at least two prescriptions for any antipsychotic medication and has a medication possession ratio (MPR) of 0.8 or greater. This code is used to identify patients who have been consistently adherent to their antipsychotic medication regimen.

1. What is HCPCS G9369?

HCPCS code G9369 is a specific code used in medical coding to identify patients who have filled at least two prescriptions for any antipsychotic medication and have a medication possession ratio (MPR) of 0.8 or greater. The MPR is a measure of medication adherence and indicates the percentage of time a patient has access to their prescribed medication over a specific period.

2. Official Description

The official description of HCPCS code G9369 is “Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater.” The short description for this code is “Fill 2 rx antipsych.”

3. Procedure

1. The provider must first ensure that the patient has filled at least two prescriptions for any antipsychotic medication.
2. The provider should calculate the patient’s medication possession ratio (MPR) by dividing the total days’ supply of antipsychotic medication by the total number of days in the measurement period.
3. If the MPR is 0.8 or greater, the provider can assign HCPCS code G9369 to indicate the patient’s adherence to their antipsychotic medication regimen.

4. When to use HCPCS code G9369

HCPCS code G9369 should be used when a patient has filled at least two prescriptions for any antipsychotic medication and has a medication possession ratio (MPR) of 0.8 or greater. This code is used to identify patients who have demonstrated consistent adherence to their antipsychotic medication regimen.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9369, healthcare providers should ensure that the patient’s medical records clearly document the filled prescriptions for antipsychotic medication and the calculation of the medication possession ratio (MPR). This documentation is necessary to support the use of this code and to demonstrate the patient’s adherence to their medication regimen.

6. Historical Information and Code Maintenance

HCPCS code G9369 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.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the services or supplies associated with HCPCS code G9369. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value for this code is not established. Providers should refer to the Medicare and insurance coverage guidelines for specific reimbursement information.

8. Examples

Here are five examples of when HCPCS code G9369 should be billed:

1. A patient has filled two prescriptions for an antipsychotic medication and has a medication possession ratio (MPR) of 0.9.
2. A patient has filled three prescriptions for different antipsychotic medications and has a medication possession ratio (MPR) of 0.85.
3. A patient has filled two prescriptions for an antipsychotic medication and has a medication possession ratio (MPR) of 0.8.
4. A patient has filled four prescriptions for different antipsychotic medications and has a medication possession ratio (MPR) of 0.95.
5. A patient has filled two prescriptions for an antipsychotic medication and has a medication possession ratio (MPR) of 1.0.