How To Use HCPCS Code G9426

HCPCS code G9426 describes the improvement in median time from emergency department (ED) arrival to initial ED oral or parenteral pain medication administration performed for ED admitted patients. This code is used to track and report the time it takes for patients in the ED to receive pain medication after their arrival.

1. What is HCPCS G9426?

HCPCS code G9426 is a specific code used in medical coding to identify the improvement in median time from ED arrival to initial ED oral or parenteral pain medication administration for ED admitted patients. It is important to note that this code is specific to the time it takes for patients to receive pain medication in the ED.

2. Official Description

The official description of HCPCS code G9426 is “Improvement in median time from ED arrival to initial ED oral or parenteral pain medication administration performed for ED admitted patients.” The short description for this code is “Impr med time edarr pain med.”

3. Procedure

1. Upon the arrival of a patient in the ED, the healthcare provider assesses the patient’s condition and determines the need for pain medication.
2. If the patient requires pain medication, the provider administers the medication orally or parenterally, depending on the patient’s condition and the healthcare facility’s protocols.
3. The provider records the time of medication administration and documents it in the patient’s medical record.
4. The improvement in median time from ED arrival to initial ED oral or parenteral pain medication administration is calculated based on the data collected for a specific period.

4. When to use HCPCS code G9426

HCPCS code G9426 should be used when reporting the improvement in median time from ED arrival to initial ED oral or parenteral pain medication administration for ED admitted patients. It is important to use this code only in the context of pain medication administration and for patients who have been admitted to the ED.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9426, healthcare providers need to document the following information:

• Date and time of the patient’s arrival in the ED
• Date and time of the initial oral or parenteral pain medication administration
• Details of the pain medication administered
• Documentation supporting the improvement in median time from ED arrival to initial ED oral or parenteral pain medication administration

6. Historical Information and Code Maintenance

HCPCS code G9426 was added to the Healthcare Common Procedure Coding System on January 01, 2015. 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.

7. Medicare and Insurance Coverage

Medicare and other insurance coverage for HCPCS code G9426 may vary. It is important to check with the specific insurance provider to determine if this code is payable and to understand the pricing and coverage guidelines. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. The multiple pricing indicator code is 9, which indicates that the value is not established or the code is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9426 should be billed:

1. A patient arrives at the ED with severe abdominal pain. The healthcare provider assesses the patient and administers oral pain medication within 30 minutes of the patient’s arrival.
2. An ED admitted patient presents with a fractured arm. The provider administers parenteral pain medication within 20 minutes of the patient’s arrival.
3. A patient arrives at the ED with a migraine headache. The provider administers oral pain medication within 45 minutes of the patient’s arrival.
4. An ED admitted patient presents with a kidney stone. The provider administers parenteral pain medication within 15 minutes of the patient’s arrival.
5. A patient arrives at the ED with a sprained ankle. The provider administers oral pain medication within 25 minutes of the patient’s arrival.