How To Use HCPCS Code G9517

HCPCS code G9517 describes a situation where a patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, and the reason for this lack of improvement is not given. This code is used to indicate that the patient’s visual acuity did not improve as expected after surgery, and it is important for medical coders to understand how to correctly use this code in their billing and coding processes.

1. What is HCPCS G9517?

HCPCS code G9517 is a specific code used in medical coding to identify cases where a patient did not achieve an improvement in visual acuity within 90 days of surgery, and the reason for this lack of improvement is not provided. It is important to note that this code does not provide any information about the specific surgery or procedure performed, but rather focuses on the outcome of the surgery in terms of visual acuity improvement.

2. Official Description

The official description of HCPCS code G9517 is “Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given.” The short description for this code is “No improvement in visual acuity within 90 days.”

3. Procedure

1. Perform a thorough assessment of the patient’s visual acuity before the surgery.
2. Perform the necessary surgical procedure to address the patient’s visual acuity issues.
3. Monitor the patient’s visual acuity closely in the postoperative period.
4. Evaluate the patient’s visual acuity at the 90-day mark after the surgery.
5. Determine if there has been any improvement in the patient’s visual acuity compared to their preoperative level.
6. If there is no improvement in visual acuity, document the lack of improvement and the reason for it not being given.

4. When to use HCPCS code G9517

HCPCS code G9517 should be used when a patient does not achieve an improvement in visual acuity within 90 days of surgery, and the reason for this lack of improvement is not provided. It is important to accurately document and code this information to ensure proper billing and reimbursement.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9517, healthcare providers should ensure that the lack of improvement in visual acuity is clearly documented in the patient’s medical record. The documentation should also include the reason for the lack of improvement, if known. This information is crucial for accurate billing and coding.

6. Historical Information and Code Maintenance

HCPCS code G9517 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. It is important for medical coders to stay updated on any changes or revisions to this code.

7. Medicare and Insurance Coverage

HCPCS code G9517 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the service is either not covered, 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. Medical coders should be aware of these pricing indicators when submitting claims for reimbursement.

8. Examples

Here are five examples of when HCPCS code G9517 should be billed:

1. A patient undergoes cataract surgery but does not experience any improvement in visual acuity within 90 days of the procedure.
2. A patient undergoes LASIK surgery but does not achieve the expected improvement in visual acuity within 90 days.
3. A patient undergoes corneal transplant surgery but does not see any improvement in visual acuity within the specified timeframe.
4. A patient undergoes refractive lens exchange surgery but does not experience any improvement in visual acuity within 90 days.
5. A patient undergoes glaucoma surgery but does not achieve the desired improvement in visual acuity within the specified timeframe.