How To Use HCPCS Code G9514

HCPCS code G9514 describes a situation where a patient requires a return to the operating room within 90 days of their initial surgery. This code is used to indicate that the patient needs additional surgical intervention within a relatively short period of time after their initial procedure.

1. What is HCPCS G9514?

HCPCS code G9514 is specifically used to identify cases where a patient requires a return to the operating room within 90 days of their initial surgery. It is important to note that this code is only applicable for situations where the patient needs to undergo another surgical procedure within this time frame.

2. Official Description

The official description of HCPCS code G9514 is “Patient required a return to the operating room within 90 days of surgery.” The short description for this code is “Req ret or w/in 90d of surg.”

3. Procedure

1. The provider should evaluate the patient’s condition and determine the need for a return to the operating room within 90 days of the initial surgery.
2. If it is determined that another surgical procedure is necessary, the provider should schedule the patient for the procedure.
3. The provider should perform the necessary pre-operative preparations, including obtaining informed consent from the patient.
4. The patient should be brought into the operating room and prepared for the surgical procedure.
5. The provider should perform the necessary surgical intervention as required by the patient’s condition.
6. After the procedure, the patient should be monitored and provided with appropriate post-operative care.

4. When to use HCPCS code G9514

HCPCS code G9514 should be used when a patient requires a return to the operating room within 90 days of their initial surgery. This code is specifically for cases where another surgical procedure is necessary within this time frame. It is important to accurately document and code this information to ensure proper reimbursement and tracking of the patient’s healthcare services.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9514, healthcare providers should ensure that the necessary documentation is in place to support the need for a return to the operating room within 90 days of the initial surgery. This may include medical records, surgical reports, and any other relevant documentation that demonstrates the medical necessity of the additional procedure. Providers should also follow the appropriate billing guidelines and coding conventions to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9514 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 code remains relevant for cases where a patient requires a return to the operating room within 90 days of their initial surgery.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G9514 may vary depending on the carrier judgment. It is important for healthcare providers to check with the specific insurance carrier or Medicare to determine the coverage and reimbursement policies for this code. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. Providers should consult the Medicare fee schedule or other relevant pricing resources for information on how this service is priced.

8. Examples

Here are five examples of when HCPCS code G9514 should be billed:

1. A patient undergoes a surgical procedure and experiences complications that require a return to the operating room within 90 days.
2. A patient undergoes a surgery and develops an infection that necessitates another surgical intervention within the 90-day period.
3. A patient undergoes a surgical procedure and experiences a post-operative bleeding that requires immediate surgical attention within 90 days.
4. A patient undergoes a surgery and develops a surgical site infection that requires debridement and further surgical treatment within the 90-day period.
5. A patient undergoes a surgical procedure and experiences a failure of the initial surgery, necessitating a revision surgery within 90 days.