How To Use HCPCS Code G9474

HCPCS code G9474 describes the services performed by a dietary counselor in the hospice setting, with each session lasting for 15 minutes. This code is used to identify and bill for diet counseling services provided to patients in a hospice care facility. In this article, we will explore the details of HCPCS code G9474, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9474?

HCPCS code G9474 is specifically used to identify and bill for diet counseling services provided by a dietary counselor in the hospice setting. This code is used to indicate that the services rendered involve counseling patients on dietary matters, such as meal planning, nutritional requirements, and dietary restrictions, in the context of hospice care.

2. Official Description

The official description of HCPCS code G9474 is “Services performed by dietary counselor in the hospice setting, each 15 minutes.” The short description for this code is “Diet counsel at hospice.”

3. Procedure

1. The dietary counselor assesses the nutritional needs and requirements of the hospice patient.
2. Based on the assessment, the counselor develops an individualized diet plan for the patient.
3. The counselor educates the patient and their caregivers on the recommended dietary changes and modifications.
4. Regular counseling sessions are conducted, each lasting for 15 minutes, to monitor the patient’s progress and provide ongoing support and guidance.
5. The counselor may also collaborate with other members of the healthcare team, such as physicians and nurses, to ensure coordinated care.

4. When to use HCPCS code G9474

HCPCS code G9474 should be used when a dietary counselor provides counseling services to hospice patients. It is important to note that this code is specific to the hospice setting and should not be used for diet counseling services provided in other healthcare settings. The counseling sessions should focus on addressing the unique dietary needs and challenges faced by hospice patients.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9474, healthcare providers need to ensure proper documentation to support the claim. The documentation should include:

• Documentation of the patient’s nutritional assessment and any relevant medical conditions or dietary restrictions.
• Documentation of the individualized diet plan developed for the patient.
• Documentation of the counseling sessions conducted, including the date, duration, and topics discussed.
• Any collaboration or coordination with other members of the healthcare team should also be documented.

6. Historical Information and Code Maintenance

HCPCS code G9474 was added to the Healthcare Common Procedure Coding System on January 01, 2016. 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. This suggests that the code has remained unchanged since its inception.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G9474 may vary. It is important to check with the specific payer for their coverage policies and guidelines. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare or other insurers. The multiple pricing indicator code is 9, which means that the value for this code is not established. This further suggests that the code may not have a separate payment rate.

8. Examples

Here are five examples of scenarios where HCPCS code G9474 should be billed:

1. A dietary counselor provides diet counseling services to a hospice patient with specific dietary restrictions due to a medical condition.
2. A dietary counselor conducts regular counseling sessions with a hospice patient to monitor their nutritional intake and provide guidance on maintaining a balanced diet.
3. A dietary counselor collaborates with the hospice care team to develop an individualized diet plan for a patient with complex nutritional needs.
4. A dietary counselor educates the caregivers of a hospice patient on proper meal planning and preparation to ensure the patient’s nutritional needs are met.
5. A dietary counselor provides counseling services to a hospice patient who is experiencing difficulty with appetite and weight loss, aiming to improve their nutritional status.