How To Use HCPCS Code G9519

HCPCS code G9519 describes the final refraction achieved by a patient within 90 days of surgery, with a spherical equivalent of +/- 1.0 diopters of their planned refraction. This code is used to indicate the successful outcome of the surgical procedure and the patient’s ability to achieve the desired visual acuity.

1. What is HCPCS G9519?

HCPCS code G9519 is a specific code used in medical coding to identify the final refraction achieved by a patient after surgery. It indicates that the patient’s post-operative vision is within the acceptable range of +/- 1.0 diopters of their planned refraction. This code is important for documenting the success of the surgical procedure and ensuring that the patient has achieved the desired visual outcome.

2. Official Description

The official description of HCPCS code G9519 is “Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery.” The short description is “Final ref +/- 1.0 w/in 90d.” These descriptions accurately summarize the purpose and criteria for using this code.

3. Procedure

1. The provider performs the surgical procedure on the patient.
2. After the surgery, the patient’s vision is assessed.
3. A refraction test is conducted to determine the patient’s visual acuity.
4. The results of the refraction test are compared to the planned refraction.
5. If the patient’s refraction falls within +/- 1.0 diopters of the planned refraction, HCPCS code G9519 is used to indicate the successful outcome.

4. When to use HCPCS code G9519

HCPCS code G9519 should be used when a patient achieves a final refraction within 90 days of surgery, with a spherical equivalent of +/- 1.0 diopters of their planned refraction. It is important to note that this code is specific to the post-operative period and should not be used for other purposes or conditions.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9519, healthcare providers need to document the surgical procedure performed, the date of the surgery, and the results of the refraction test. It is important to include the planned refraction and the patient’s actual refraction, indicating whether it falls within the acceptable range of +/- 1.0 diopters. This documentation is crucial for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9519 was added to the Healthcare Common Procedure Coding System on January 01, 2016. As of January 01, 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 has been in use for several years without significant changes or revisions.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the services associated with HCPCS code G9519, depending on the carrier’s judgment. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This indicates that the service may be bundled or not covered by Medicare. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS code G9519 is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9519 should be billed:

1. A patient undergoes cataract surgery and achieves a final refraction within +/- 1.0 diopters of their planned refraction within 90 days of the procedure.
2. A patient undergoes LASIK surgery and achieves a final refraction within +/- 1.0 diopters of their planned refraction within 90 days of the procedure.
3. A patient undergoes PRK surgery and achieves a final refraction within +/- 1.0 diopters of their planned refraction within 90 days of the procedure.
4. A patient undergoes lens replacement surgery and achieves a final refraction within +/- 1.0 diopters of their planned refraction within 90 days of the procedure.
5. A patient undergoes corneal transplant surgery and achieves a final refraction within +/- 1.0 diopters of their planned refraction within 90 days of the procedure.