How To Use HCPCS Code G9536

HCPCS code G9536 describes the documentation of medical reasons for ordering an advanced brain imaging study. This code is used when a patient presents with specific symptoms or conditions that warrant further investigation through advanced brain imaging. In this article, we will explore the details of HCPCS code G9536, 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 G9536?

HCPCS code G9536 is a specific code used to document the medical reasons for ordering an advanced brain imaging study. It is important for healthcare providers to accurately use this code when ordering advanced brain imaging for patients who meet the specified criteria. This code helps in ensuring proper documentation and billing for the services provided.

2. Official Description

The official description of HCPCS code G9536 is as follows: “Documentation of medical reason(s) for ordering an advanced brain imaging study.” The short description for this code is “Doc med reas adv brain image.”

3. Procedure

1. The healthcare provider must thoroughly evaluate the patient’s symptoms and medical history to determine if an advanced brain imaging study is necessary.
2. If the patient meets any of the specified medical reasons for ordering an advanced brain imaging study, the provider should document these reasons in the patient’s medical record.
3. The documentation should clearly state the specific symptoms or conditions that justify the need for an advanced brain imaging study.
4. The provider should ensure that the documentation is detailed and specific, providing sufficient information to support the medical necessity of the procedure.
5. Once the documentation is complete, the provider can use HCPCS code G9536 to indicate that the medical reasons for ordering an advanced brain imaging study have been documented.

4. When to use HCPCS code G9536

HCPCS code G9536 should be used when a patient presents with specific symptoms or conditions that warrant further investigation through advanced brain imaging. The following are some examples of when this code may be appropriate:

• Patient has an abnormal neurological examination
• Patient has the coexistence of seizures, or both
• Recent onset of severe headache
• Change in the type of headache
• Signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation)
• HIV-positive patients with a new type of headache
• Immunocompromised patient with unexplained headache symptoms
• Patient on coagulopathy/anti-coagulation or anti-platelet therapy
• Very young patients with unexplained headache symptoms

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9536, healthcare providers need to ensure that the documentation supports the medical necessity of ordering an advanced brain imaging study. The documentation should clearly state the specific symptoms or conditions that justify the need for the procedure. It is important to provide detailed and specific information to support the medical necessity and ensure accurate billing.

6. Historical Information and Code Maintenance

HCPCS code G9536 was added to the Healthcare Common Procedure Coding System on January 1, 2016. It has a termination date of December 31, 2018. No maintenance actions have been taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G9536 may vary. It is important for healthcare providers to check with the specific payer to determine if this code is payable. The pricing indicator code for this code is 00, which means the service 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.

8. Examples

Here are some examples of when HCPCS code G9536 should be billed:

1. Example 1: A patient presents with an abnormal neurological examination, and the healthcare provider orders an advanced brain imaging study to further evaluate the underlying cause.
2. Example 2: A patient with a history of seizures experiences a change in the type of headache, and the healthcare provider orders an advanced brain imaging study to assess any potential neurological abnormalities.
3. Example 3: A patient, who is HIV-positive, complains of a new type of headache, and the healthcare provider orders an advanced brain imaging study to rule out any serious underlying conditions.
4. Example 4: An immunocompromised patient presents with unexplained headache symptoms, and the healthcare provider orders an advanced brain imaging study to investigate the possible causes.
5. Example 5: A very young patient exhibits unexplained headache symptoms, and the healthcare provider orders an advanced brain imaging study to ensure early detection of any potential issues.