How To Use HCPCS Code G9475

HCPCS code G9475 describes services performed by other counselors in the hospice setting, with each session lasting 15 minutes. This code is used to identify and bill for the services provided by counselors who are not the primary counselor in the hospice team. It is important for medical coders to understand the specific usage and guidelines for this code to ensure accurate billing and reimbursement.

1. What is HCPCS G9475?

HCPCS code G9475 is used to identify services performed by other counselors in the hospice setting, with each session lasting 15 minutes. These counselors provide support and counseling to patients in a hospice care environment. The code is specific to the services provided by counselors who are not the primary counselor in the hospice team.

2. Official Description

The official description of HCPCS code G9475 is “Services performed by other counselor in the hospice setting, each 15 minutes.” The short description for this code is “Other counselor at hospice.”

3. Procedure

1. The provider begins by assessing the patient’s needs and determining the appropriate counseling services required.
2. The other counselor conducts counseling sessions with the patient, addressing their emotional, psychological, and spiritual needs.
3. The counselor may use various therapeutic techniques and interventions to support the patient and their family members.
4. Each counseling session lasts for 15 minutes, and the counselor documents the services provided during each session.
5. The counselor may collaborate with other members of the hospice team to ensure comprehensive care for the patient.

4. When to use HCPCS code G9475

HCPCS code G9475 should be used when counseling services are provided by other counselors in the hospice setting. These counselors are not the primary counselor in the hospice team but play a crucial role in supporting the emotional well-being of the patient and their family members. It is important to ensure that the services meet the specific criteria outlined in the code description.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9475, healthcare providers need to document the counseling services provided by the other counselor in the hospice setting. The documentation should include the date, duration, and nature of the counseling session. It is important to maintain accurate and detailed records to support the billed services.

6. Historical Information and Code Maintenance

HCPCS code G9475 was added to the Healthcare Common Procedure Coding System on January 01, 2016. As of the effective date, 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 code is still active and can be used for billing purposes.

7. Medicare and Insurance Coverage

The coverage for HCPCS code G9475 is determined by the carrier’s judgment. Medicare and other insurance providers may have specific guidelines and policies regarding the reimbursement for counseling services in the hospice setting. It is important to review the individual payer’s guidelines to ensure compliance and accurate billing.

8. Examples

Here are five examples of when HCPCS code G9475 should be billed:

1. A patient receives counseling services from a secondary counselor in the hospice setting for 45 minutes.
2. A counselor provides counseling sessions to a patient’s family members in the hospice setting, with each session lasting 15 minutes.
3. A patient receives counseling services from a secondary counselor in the hospice setting for a total of 60 minutes, divided into four 15-minute sessions.
4. A counselor conducts a counseling session with a patient in the hospice setting for 30 minutes.
5. A patient receives counseling services from a secondary counselor in the hospice setting for 90 minutes, divided into six 15-minute sessions.