How To Use HCPCS Code G9381

HCPCS code G9381 describes the documentation of medical reason(s) for not offering assistance with end of life issues during the measurement period. This code is used to indicate that the healthcare provider has documented the reasons why they did not provide assistance with end of life issues, such as when a patient is in hospice care or in the terminal phase of their illness.

1. What is HCPCS G9381?

HCPCS code G9381 is a specific code used in medical coding to identify the documentation of medical reason(s) for not offering assistance with end of life issues. It is important for healthcare providers to accurately use this code to ensure proper documentation and billing for the services provided.

2. Official Description

The official description of HCPCS code G9381 is “Documentation of medical reason(s) for not offering assistance with end of life issues (e.g., patient in hospice care, patient in terminal phase) during the measurement period.” This description clearly outlines the purpose of this code and the specific circumstances under which it should be used.

3. Procedure

1. During the measurement period, the healthcare provider should thoroughly document the medical reason(s) for not offering assistance with end of life issues.
2. This documentation should include details about the patient’s condition, such as being in hospice care or in the terminal phase of their illness.
3. The provider should clearly explain why they did not provide assistance with end of life issues, ensuring that all relevant information is included in the documentation.
4. It is important for the provider to accurately and comprehensively document the medical reason(s) to support the use of HCPCS code G9381.

4. When to use HCPCS code G9381

HCPCS code G9381 should be used when the healthcare provider has documented the medical reason(s) for not offering assistance with end of life issues during the measurement period. This code is specifically used in cases where the patient is in hospice care or in the terminal phase of their illness.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9381, healthcare providers should ensure that the documentation clearly supports the medical reason(s) for not offering assistance with end of life issues. The documentation should include details about the patient’s condition, such as being in hospice care or in the terminal phase of their illness. It is important to accurately and thoroughly document the medical reason(s) to ensure proper billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9381 was added to the Healthcare Common Procedure Coding System on January 1, 2015. It has a termination date of December 31, 2017. This code has a coverage code of C, indicating carrier judgment, and an action code of N, indicating no maintenance for this code. The pricing indicator code for HCPCS code G9381 is 00, which means that the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value is not established for this code.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may have specific guidelines and coverage policies regarding the use of HCPCS code G9381. It is important for healthcare providers to familiarize themselves with these guidelines to ensure proper billing and reimbursement. The pricing indicator code and multiple pricing indicator code provide information on how the service or supply is priced by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code G9381 should be billed:

1. A patient is in hospice care and the healthcare provider documents the medical reason(s) for not offering assistance with end of life issues during the measurement period.
2. A patient is in the terminal phase of their illness and the healthcare provider documents the medical reason(s) for not offering assistance with end of life issues during the measurement period.
3. A patient is receiving palliative care and the healthcare provider documents the medical reason(s) for not offering assistance with end of life issues during the measurement period.
4. A patient has expressed their wish to not receive assistance with end of life issues and the healthcare provider documents the medical reason(s) for respecting the patient’s decision during the measurement period.
5. A patient’s family has requested not to discuss end of life issues and the healthcare provider documents the medical reason(s) for respecting the family’s wishes during the measurement period.