How To Use HCPCS Code G9512

HCPCS code G9512 describes an individual who has a proportion of days covered (PDC) of 0.8 or greater. This code is used to identify patients who have a high adherence to their prescribed medication regimen. It is important for medical coders to understand the meaning and usage of this code in order to accurately document and bill for the services provided.

1. What is HCPCS G9512?

HCPCS code G9512 is used to indicate that an individual has a PDC of 0.8 or greater. The PDC is a measure of medication adherence and represents the proportion of days in a specific time period that a patient has access to the prescribed medication. A PDC of 0.8 or greater indicates that the patient has been adherent to their medication regimen for at least 80% of the time.

2. Official Description

The official description of HCPCS code G9512 is “Indiv pdc > 0.8.” This short description succinctly conveys that the code is used to identify individuals with a PDC greater than 0.8.

3. Procedure

1. Obtain the necessary patient information, including medication history and prescription records.
2. Calculate the PDC by dividing the number of days the patient had access to the medication by the total number of days in the specified time period.
3. If the calculated PDC is 0.8 or greater, assign HCPCS code G9512 to indicate the high medication adherence.

4. When to use HCPCS code G9512

HCPCS code G9512 should be used when documenting and billing for services provided to individuals who have a PDC of 0.8 or greater. This code is applicable in situations where medication adherence is an important factor to consider, such as chronic disease management or medication therapy management.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9512, healthcare providers should ensure that the patient’s medication adherence is accurately documented in the medical record. This may include information on the prescribed medication, the duration of the medication regimen, and any relevant patient education or counseling provided. Additionally, providers should follow the appropriate billing guidelines and submit the code on the claim form according to the payer’s requirements.

6. Historical Information and Code Maintenance

HCPCS code G9512 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 remains valid and can be used to identify individuals with a PDC of 0.8 or greater.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover services or supplies associated with HCPCS code G9512. 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. Providers should consult the Medicare fee schedule or contact the insurance provider for specific coverage and reimbursement information.

8. Examples

Here are five examples of when HCPCS code G9512 should be billed:

1. A patient with diabetes who consistently takes their prescribed insulin medication with a PDC of 0.9.
2. An individual with hypertension who adheres to their antihypertensive medication regimen with a PDC of 0.85.
3. A patient with asthma who regularly uses their prescribed inhaler medication with a PDC of 0.95.
4. An individual with HIV who consistently takes their antiretroviral medication with a PDC of 0.8.
5. A patient with depression who adheres to their antidepressant medication regimen with a PDC of 0.87.