How To Use HCPCS Code G9605

HCPCS code G9605 describes a situation where a patient survey score did not improve from baseline following treatment. This code is used to indicate that despite receiving treatment, the patient’s survey score did not show any improvement.

1. What is HCPCS G9605?

HCPCS code G9605 is a specific code used in medical coding to identify cases where a patient’s survey score did not improve from baseline after receiving treatment. It is important to note that this code is only applicable when there is no improvement in the patient’s survey score despite undergoing treatment.

2. Official Description

The official description of HCPCS code G9605 is “Patient survey score did not improve from baseline following treatment.” The short description for this code is “Surv score no improv w/tx.” This description accurately reflects the purpose of the code, indicating that the patient’s survey score did not show any improvement after receiving treatment.

3. Procedure

  1. During the coding process, the medical coder should review the patient’s medical records and identify if there was a baseline survey score recorded before the treatment.
  2. The coder should then determine if there was any improvement in the patient’s survey score after the treatment was administered.
  3. If the survey score did not improve from the baseline, the coder should assign HCPCS code G9605 to accurately reflect this situation.

4. When to use HCPCS code G9605

HCPCS code G9605 should be used when a patient’s survey score does not show any improvement from the baseline after receiving treatment. It is important to note that this code is only applicable in cases where a survey score is used to measure the effectiveness of the treatment.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9605, healthcare providers need to ensure that the patient’s medical records clearly document the baseline survey score, the treatment provided, and the subsequent survey score after the treatment. This documentation is crucial for accurate coding and billing.

6. Historical Information and Code Maintenance

HCPCS code G9605 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 remains relevant for cases where a patient’s survey score does not improve from baseline following treatment.

7. Medicare and Insurance Coverage

HCPCS code G9605 is subject to carrier judgment when it comes to coverage. This means that Medicare and other insurance providers may make a determination on whether to cover this code based on their own guidelines and policies. It is important for healthcare providers to verify coverage with the respective payers before submitting claims.

8. Examples

Here are five examples of scenarios where HCPCS code G9605 should be billed:

  1. A patient undergoes a series of physical therapy sessions to improve their mobility. Despite completing the recommended treatment, the patient’s survey score assessing their functional abilities does not show any improvement.
  2. An individual receives counseling sessions to address their mental health concerns. However, their survey score measuring their emotional well-being remains unchanged after the treatment.
  3. A patient undergoes a weight loss program that includes dietary changes and exercise. Despite adhering to the program, their survey score measuring their overall satisfaction with the program does not improve.
  4. An individual receives medication and therapy for the management of their chronic pain. However, their survey score assessing their pain levels does not show any improvement after the treatment.
  5. A patient undergoes a surgical procedure to address a specific medical condition. Despite the successful surgery, their survey score measuring their quality of life does not improve from the baseline.

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