How To Use HCPCS Code G9595

HCPCS code G9595 describes a specific documentation requirement for patients who have a ventricular shunt, brain tumor, or coagulopathy. This code is used to indicate that the healthcare provider has documented the presence of one of these conditions in the patient’s medical record. In this article, we will explore the details of HCPCS code G9595, 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 G9595?

HCPCS code G9595 is a specific code used to indicate that the patient has documentation of a ventricular shunt, brain tumor, or coagulopathy. It is important for medical coders to accurately assign this code when the provider has documented the presence of one of these conditions in the patient’s medical record.

2. Official Description

The official description of HCPCS code G9595 is “Patient has documentation of ventricular shunt, brain tumor, or coagulopathy.” The short description for this code is “Doc shnt/tum/coag.”

3. Procedure

1. Review the patient’s medical record to determine if there is documentation of a ventricular shunt, brain tumor, or coagulopathy.
2. If the documentation is present, assign HCPCS code G9595 to indicate that the patient has documentation of one of these conditions.
3. Ensure that the code is accurately recorded in the patient’s medical billing and coding records.

4. When to use HCPCS code G9595

HCPCS code G9595 should be used when the healthcare provider has documented the presence of a ventricular shunt, brain tumor, or coagulopathy in the patient’s medical record. It is important to note that this code should only be used if there is clear documentation of one of these conditions.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9595, healthcare providers need to ensure that there is proper documentation of the ventricular shunt, brain tumor, or coagulopathy in the patient’s medical record. This documentation should include relevant details such as the type and location of the condition, any associated symptoms or complications, and the provider’s assessment and plan for managing the condition.

6. Historical Information and Code Maintenance

HCPCS code G9595 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 is classified as a medical care service and is not separately priced by Part B.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G9595 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 that the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that it is not applicable as HCPCS code G9595 is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9595 should be billed:

1. A patient with a documented ventricular shunt undergoes a follow-up visit with their neurosurgeon.
2. A patient with a documented brain tumor receives radiation therapy.
3. A patient with a documented coagulopathy undergoes a blood transfusion.
4. A patient with a documented ventricular shunt undergoes an MRI scan.
5. A patient with a documented brain tumor undergoes a surgical procedure for tumor removal.