How To Use HCPCS Code G9521

HCPCS code G9521 describes the total number of emergency department visits and inpatient hospitalizations that are less than two in the past 12 months. This code is used to indicate the frequency of emergency department visits and hospitalizations for a patient within a specific time frame. In this article, we will explore the details of HCPCS code G9521, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9521?

HCPCS code G9521 is a specific code used in medical coding to identify the total number of emergency department visits and inpatient hospitalizations that are less than two in the past 12 months. This code provides important information about the frequency of emergency department visits and hospitalizations for a patient within a specific time period.

2. Official Description

The official description of HCPCS code G9521 is “Er and ip hosp <2 in 12 mos." This description indicates that the code is used to represent the total number of emergency department visits and inpatient hospitalizations that are less than two within a 12-month period.

3. Procedure

1. Step 1: Gather the necessary medical records and documentation related to the patient’s emergency department visits and inpatient hospitalizations.
2. Step 2: Review the medical records to determine the total number of emergency department visits and inpatient hospitalizations that occurred within the past 12 months.
3. Step 3: Assign HCPCS code G9521 to indicate the total number of emergency department visits and inpatient hospitalizations that are less than two in the past 12 months.

4. When to use HCPCS code G9521

HCPCS code G9521 should be used when documenting and coding the total number of emergency department visits and inpatient hospitalizations that are less than two within a 12-month period. This code helps to provide a comprehensive picture of the patient’s healthcare utilization and can be used for various purposes, such as research, quality assessment, and reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9521, healthcare providers need to ensure that the medical records and documentation clearly support the total number of emergency department visits and inpatient hospitalizations that are being reported. It is important to accurately document the dates and details of each visit or hospitalization to ensure proper coding and billing.

6. Historical Information and Code Maintenance

HCPCS code G9521 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 has remained unchanged since its addition to the HCPCS.

7. Medicare and Insurance Coverage

HCPCS code G9521 is covered by Medicare and other insurance providers. However, it is important to note that this code is not separately priced by Part B. The pricing indicator code for HCPCS code G9521 is 00, which means that the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value for this code is not established.

8. Examples

Here are five examples of when HCPCS code G9521 should be billed:

1. Example 1: A patient had one emergency department visit and one inpatient hospitalization within the past 12 months.
2. Example 2: A patient had no emergency department visits and one inpatient hospitalization within the past 12 months.
3. Example 3: A patient had two emergency department visits and no inpatient hospitalizations within the past 12 months.
4. Example 4: A patient had no emergency department visits and no inpatient hospitalizations within the past 12 months.
5. Example 5: A patient had one emergency department visit and no inpatient hospitalizations within the past 12 months.