How To Use HCPCS Code G9522

HCPCS code G9522 describes the total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given. 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 G9522, 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 G9522?

HCPCS code G9522 is a specific code used in medical coding to identify the total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given. It provides information about the frequency of emergency department visits and hospitalizations for a patient within a specific time frame.

2. Official Description

The official description of HCPCS code G9522 is “Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given.” The short description for this code is “Er/ip hosp =/>2 in 12 mos.”

3. Procedure

1. When using HCPCS code G9522, the healthcare provider should review the patient’s medical records to determine the total number of emergency department visits and inpatient hospitalizations within the past 12 months.
2. If the patient has had two or more emergency department visits and inpatient hospitalizations within the specified time frame, the provider should document this information.
3. If the patient has not been screened for emergency department visits and inpatient hospitalizations, and the reason for not screening is not given, the provider should also document this information.
4. The provider should accurately report the HCPCS code G9522 on the claim form or medical billing software.

4. When to use HCPCS code G9522

HCPCS code G9522 should be used when a patient has had two or more emergency department visits and inpatient hospitalizations within the past 12 months. It is also used when the patient has not been screened for emergency department visits and inpatient hospitalizations, and the reason for not screening is not given. This code helps to provide a comprehensive picture of the patient’s healthcare utilization and can be used for tracking purposes.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9522, healthcare providers need to ensure accurate and detailed documentation. The medical records should clearly indicate the total number of emergency department visits and inpatient hospitalizations within the past 12 months. If the patient has not been screened for emergency department visits and inpatient hospitalizations, the reason for not screening should be documented. This information is crucial for proper billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9522 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. The code has a pricing indicator code of 00, which means it is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

7. Medicare and Insurance Coverage

HCPCS code G9522 may be covered by Medicare and other insurance providers. However, the pricing indicator code of 00 suggests that it is not separately priced by Part B. This means that the service or supply represented by this code may be bundled or not covered by Medicare or other insurers. Healthcare providers should verify the coverage and reimbursement policies of the specific payer before submitting claims with HCPCS code G9522.

8. Examples

Here are five examples of when HCPCS code G9522 should be billed:

1. A patient has had three emergency department visits and four inpatient hospitalizations within the past 12 months.
2. A patient has not been screened for emergency department visits and inpatient hospitalizations, and the reason for not screening is not given.
3. A patient has had two emergency department visits and one inpatient hospitalization within the past 12 months.
4. A patient has not been screened for emergency department visits and inpatient hospitalizations, and the reason for not screening is documented as patient refusal.
5. A patient has had five emergency department visits and two inpatient hospitalizations within the past 12 months.