How To Use HCPCS Code G9604

HCPCS code G9604 describes a situation where patient survey results are not available. This code is used to indicate that the necessary survey results for a patient are not accessible or have not been obtained. In this article, we will explore the details of HCPCS code G9604, 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 G9604?

HCPCS code G9604 is used to identify a scenario where patient survey results are not available. It indicates that the necessary survey results, which may be required for certain healthcare procedures or assessments, are not accessible or have not been obtained. This code helps healthcare providers and payers to accurately document and track the availability of patient survey results.

2. Official Description

The official description of HCPCS code G9604 is “Patient survey results not available.” This description clearly states that this code is used when the survey results for a patient are not accessible or have not been obtained. The short description for this code is “Pt surv results not avail.”

3. Procedure

  1. As HCPCS code G9604 is related to patient survey results, the procedure involves checking the availability of the required survey results for a patient.
  2. If the survey results are not available, the healthcare provider or coder should assign HCPCS code G9604 to indicate this situation.
  3. It is essential to ensure accurate documentation and coding to reflect the unavailability of patient survey results.

4. When to use HCPCS code G9604

HCPCS code G9604 should be used in situations where the necessary survey results for a patient are not accessible or have not been obtained. This code is applicable when the healthcare provider or coder has made efforts to obtain the survey results but has been unsuccessful in doing so. It is important to use this code only when the survey results are genuinely unavailable and not simply due to oversight or incomplete documentation.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9604, healthcare providers need to ensure accurate documentation and coding to support the unavailability of patient survey results. The medical record should clearly indicate the efforts made to obtain the survey results and the reasons for their unavailability. This documentation is crucial for proper reimbursement and to demonstrate the necessity of the procedure or assessment being performed without the survey results.

6. Historical Information and Code Maintenance

HCPCS code G9604 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. This code has remained unchanged since its inclusion in the coding system.

7. Medicare and Insurance Coverage

HCPCS code G9604 is covered by Medicare and other insurance providers. However, it is important to note that this code does not have a separate pricing indicator code, as it is not separately priced by Part B. This means that the service or procedure associated with this code is not separately reimbursed and may be bundled or included in other services. Healthcare providers should review the specific reimbursement policies of Medicare and other insurance carriers to determine the coverage and payment for procedures or assessments involving HCPCS code G9604.

8. Examples

Here are five examples of scenarios where HCPCS code G9604 should be billed:

  1. A patient’s survey results were not available due to technical issues with the survey system, and the healthcare provider proceeded with the necessary procedure based on clinical judgment.
  2. A patient’s survey results were not obtained as the patient did not complete the survey despite multiple attempts by the healthcare provider.
  3. The necessary survey results for a patient were not accessible due to the patient’s unavailability or inability to provide the required information.
  4. A patient’s survey results were not available due to the survey system being temporarily offline or undergoing maintenance.
  5. The survey results for a patient were not obtained as the patient refused to participate in the survey or provide the necessary information.

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