How To Use HCPCS Code G9511

HCPCS code G9511 describes the index event date PHQ-9 or PHQ-9M score greater than 9 documented during the twelve month denominator identification period. This code is used to identify patients who have a PHQ-9 or PHQ-9M score greater than 9, indicating a moderate to severe level of depression symptoms. It is important for medical coders to understand the meaning and usage of this code in order to accurately report and bill for the services provided.

1. What is HCPCS G9511?

HCPCS code G9511 is a specific code used in medical coding to identify patients who have a documented PHQ-9 or PHQ-9M score greater than 9 during the twelve month denominator identification period. This code is used to indicate the presence of moderate to severe depression symptoms in the patient.

2. Official Description

The official description of HCPCS code G9511 is “Index event date PHQ-9 or PHQ-9M score greater than 9 documented during the twelve month denominator identification period.” The short description for this code is “Idx evt dte PHQ>9 doc 12 mo.”

3. Procedure

1. The provider should administer the PHQ-9 or PHQ-9M questionnaire to the patient.
2. The patient’s responses should be scored according to the guidelines provided for the questionnaire.
3. If the patient’s score is greater than 9, indicating moderate to severe depression symptoms, the provider should document the index event date.
4. The index event date should be recorded during the twelve month denominator identification period.

4. When to use HCPCS code G9511

HCPCS code G9511 should be used when a patient’s PHQ-9 or PHQ-9M score is greater than 9, indicating moderate to severe depression symptoms, and the index event date is documented during the twelve month denominator identification period. This code is used to identify patients who require further evaluation and treatment for their depression symptoms.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9511, healthcare providers should ensure that the patient’s PHQ-9 or PHQ-9M score is properly documented in the medical record. The index event date should also be clearly recorded. It is important to follow the specific documentation requirements set forth by the payer to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9511 was added to the Healthcare Common Procedure Coding System on January 01, 2016. As of January 01, 2019, 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 has a pricing indicator code of 00, which means it is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value for this code is not established.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may have specific coverage policies for HCPCS code G9511. It is important to review the payer’s guidelines to determine if this code is payable and how the service or supply is priced. The pricing indicator code of 00 indicates that the service is not separately priced by Part B and may be bundled or not covered by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code G9511 should be billed:

1. A patient presents to their primary care physician with symptoms of depression. The physician administers the PHQ-9 questionnaire and scores the patient’s responses. The patient’s score is 12, indicating moderate to severe depression symptoms. The physician documents the index event date and reports HCPCS code G9511.
2. A psychiatrist evaluates a patient who has been experiencing persistent feelings of sadness and loss of interest. The psychiatrist administers the PHQ-9M questionnaire and determines that the patient’s score is 10, indicating moderate depression symptoms. The psychiatrist documents the index event date and reports HCPCS code G9511.
3. A mental health counselor conducts a therapy session with a patient who has a history of depression. During the session, the counselor administers the PHQ-9 questionnaire and determines that the patient’s score is 8, indicating mild depression symptoms. Since the patient’s score is not greater than 9, HCPCS code G9511 is not reported.
4. A patient visits an outpatient behavioral health clinic for an initial assessment. The clinician administers the PHQ-9M questionnaire and scores the patient’s responses. The patient’s score is 15, indicating severe depression symptoms. The clinician documents the index event date and reports HCPCS code G9511.
5. A nurse practitioner sees a patient in a primary care setting for a follow-up visit. The patient has a history of depression and is currently taking medication for their symptoms. The nurse practitioner administers the PHQ-9 questionnaire and determines that the patient’s score is 6, indicating no depression symptoms. Since the patient’s score is not greater than 9, HCPCS code G9511 is not reported.