How To Use HCPCS Code G9510

HCPCS code G9510 describes the eligibility criteria and requirements for adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5. This code is used to indicate that either the PHQ-9 or PHQ-9M score was not assessed or is greater than or equal to 5.

1. What is HCPCS G9510?

HCPCS code G9510 is a specific code used in medical coding to identify adult patients with major depression or dysthymia who did not achieve remission at twelve months based on their PHQ-9 or PHQ-9M scores. It indicates that the patient’s score was either not assessed or is equal to or greater than 5.

2. Official Description

The official description of HCPCS code G9510 is as follows: “Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5. Either PHQ-9 or PHQ-9M score was not assessed or is greater than or equal to 5.” The short description for this code is “Remis12m not PHQ-9 score <5."

3. Procedure

1. Patients who meet the eligibility criteria for HCPCS code G9510 should be identified based on their diagnosis of major depression or dysthymia.
2. The provider should assess the patient’s PHQ-9 or PHQ-9M score at twelve months (+/-60 days) to determine if they have reached remission.
3. If the patient’s score is less than 5, indicating that they have not reached remission, HCPCS code G9510 should be used to document this status.
4. If the patient’s score was not assessed or is equal to or greater than 5, HCPCS code G9510 should also be used to indicate this.

4. When to use HCPCS code G9510

HCPCS code G9510 should be used when documenting adult patients with major depression or dysthymia who did not achieve remission at twelve months based on their PHQ-9 or PHQ-9M scores. This code is specifically for patients whose scores are either not assessed or are equal to or greater than 5.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9510, healthcare providers should ensure that the patient’s diagnosis of major depression or dysthymia is clearly documented. Additionally, the provider should include the patient’s PHQ-9 or PHQ-9M scores at twelve months (+/-60 days) to support the use of this code. Proper documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9510 was added to the Healthcare Common Procedure Coding System on January 1, 2016. As of January 1, 2020, 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 used to identify patients who did not reach remission at twelve months based on their PHQ-9 or PHQ-9M scores.

7. Medicare and Insurance Coverage

Medicare coverage for HCPCS code G9510 is determined by carrier judgment, as indicated by the coverage code C. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This code is not applicable for separate reimbursement and may be bundled or used by Part A only. The multiple pricing indicator code is 9, which means 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 G9510 should be billed:

1. A 45-year-old patient with a diagnosis of major depression who did not achieve remission at twelve months based on a PHQ-9 score of 7.
2. A 60-year-old patient with dysthymia who did not reach remission at twelve months based on a PHQ-9M score of 6.
3. An 18-year-old patient with major depression whose PHQ-9 score was not assessed at twelve months.
4. A 55-year-old patient with dysthymia whose PHQ-9M score at twelve months was 5, indicating that they did not reach remission.
5. A 70-year-old patient with major depression whose PHQ-9 score at twelve months was 4, indicating that they did not achieve remission.