How To Use HCPCS Code G9580

HCPCS code G9580 describes the door to puncture time of 90 minutes or less. This code is used to indicate the time it takes from a patient’s arrival at the hospital to the start of a puncture procedure, such as a surgery or a diagnostic test. It is important to accurately report this code to ensure proper reimbursement and to track the efficiency of healthcare facilities in providing timely care.

1. What is HCPCS G9580?

HCPCS code G9580 is a specific code used to identify the door to puncture time of 90 minutes or less. It signifies that the healthcare facility has successfully provided prompt care to the patient, ensuring that the puncture procedure begins within the specified time frame. This code is essential for tracking and monitoring the efficiency of healthcare facilities in delivering timely care.

2. Official Description

The official description of HCPCS code G9580 is “Door to puncture time of 90 minutes or less.” The short description for this code is “Door to puncture time <2hrs." These descriptions accurately convey the meaning and purpose of the code.

3. Procedure

1. Upon the patient’s arrival at the healthcare facility, the clock starts ticking for the door to puncture time.
2. The healthcare provider assesses the patient’s condition and determines the appropriate puncture procedure.
3. The necessary preparations, such as obtaining consent and ensuring the availability of equipment and personnel, are made.
4. The puncture procedure, whether it be a surgery or a diagnostic test, is performed within 90 minutes of the patient’s arrival.

4. When to use HCPCS code G9580

HCPCS code G9580 should be used when the door to puncture time is 90 minutes or less. It is important to accurately document and report this code to reflect the efficiency of healthcare facilities in providing timely care. This code is applicable in various medical settings, including hospitals, surgical centers, and diagnostic facilities.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9580, healthcare providers need to ensure proper documentation of the patient’s arrival time and the start time of the puncture procedure. This documentation should be included in the medical record to support the use of this code. Additionally, healthcare providers should follow the billing guidelines set forth by Medicare or other insurance providers to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9580 was added to the Healthcare Common Procedure Coding System on January 01, 2016. As of the effective date of January 01, 2022, 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

Medicare and other insurance providers may cover the services associated with HCPCS code G9580. However, it is important to review the specific coverage policies of each payer to determine the reimbursement eligibility. The pricing indicator code for this code is 00, indicating that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value is not established or applicable as HCPCS is not priced separately by Part B.

8. Examples

Here are five examples of scenarios where HCPCS code G9580 should be billed:

1. A patient arrives at the emergency department with a suspected appendicitis. The surgical team successfully performs an appendectomy within 90 minutes of the patient’s arrival.
2. A patient presents with stroke symptoms, and the healthcare team promptly performs a cerebral angiogram within 90 minutes of the patient’s arrival.
3. A patient is admitted to the hospital with a suspected heart attack. The cardiac catheterization procedure is initiated within 90 minutes of the patient’s arrival.
4. A patient undergoes a diagnostic laparoscopy for suspected endometriosis. The procedure is performed within 90 minutes of the patient’s arrival at the surgical center.
5. A patient arrives at a radiology facility for a CT-guided biopsy. The procedure is initiated within 90 minutes of the patient’s arrival.