How To Use HCPCS Code G9626

HCPCS code G9626 describes the documented medical reason for not reporting bladder injury. This code is used when there is a valid medical reason for not reporting a bladder injury during a procedure or surgery. It is important for medical coders to understand the specific usage and guidelines for this code to ensure accurate billing and coding practices.

1. What is HCPCS G9626?

HCPCS code G9626 is a specific code used to indicate the documented medical reason for not reporting bladder injury. It is important to note that this code should only be used when there is a valid medical reason for not reporting the bladder injury. It is not to be used in cases where the bladder injury was not documented or when there is no medical reason for not reporting it.

2. Official Description

The official description of HCPCS code G9626 is “Documented medical reason for not reporting bladder injury.” The short description for this code is “Med rsn no rpt bladder inj.” This description accurately reflects the purpose and usage of this code.

3. Procedure

  1. During the procedure or surgery, the healthcare provider should thoroughly document any bladder injury that occurs.
  2. If there is a valid medical reason for not reporting the bladder injury, such as the presence of gynecologic or other pelvic malignancy, concurrent surgery involving bladder pathology, injury during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, or patient death during the procedure without evidence of bladder injury, this code should be used.
  3. The healthcare provider should ensure that the medical reason for not reporting the bladder injury is clearly documented in the patient’s medical record.

4. When to use HCPCS code G9626

HCPCS code G9626 should be used when there is a valid medical reason for not reporting a bladder injury during a procedure or surgery. The specific contexts or conditions under which this code is used include:

  • Gynecologic or other pelvic malignancy documented
  • Concurrent surgery involving bladder pathology
  • Injury that occurs during a urinary incontinence procedure
  • Patient death from non-medical causes not related to surgery
  • Patient died during the procedure without evidence of bladder injury

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9626, healthcare providers need to ensure that the following documentation requirements are met:

  • The documented medical reason for not reporting the bladder injury should be clearly stated in the patient’s medical record.
  • Any relevant supporting documentation, such as pathology reports or surgical notes, should be included in the medical record.
  • When submitting the claim, the healthcare provider should include the appropriate HCPCS code G9626 on the claim form.

6. Historical Information and Code Maintenance

HCPCS code G9626 was added to the Healthcare Common Procedure Coding System on January 01, 2016. As of January 01, 2023, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders to stay updated on any changes or revisions to this code.

7. Medicare and Insurance Coverage

HCPCS code G9626 is covered by Medicare. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This code is typically bundled or not covered separately. The multiple pricing indicator code is 9, which indicates that the value for this code is not established. It is important for healthcare providers to review the specific coverage and reimbursement policies of Medicare and other insurance providers.

8. Examples

Here are five examples of when HCPCS code G9626 should be billed:

  1. A patient undergoes a gynecologic surgery, and a bladder injury occurs during the procedure. However, due to the presence of gynecologic malignancy, the bladder injury is not reported.
  2. A patient undergoes a surgery involving bladder pathology, and a bladder injury occurs. However, due to the concurrent surgery, the bladder injury is not reported.
  3. A patient undergoes a urinary incontinence procedure, and a bladder injury occurs. However, due to the nature of the procedure, the bladder injury is not reported.
  4. A patient dies during a surgical procedure, but the cause of death is determined to be non-medical and unrelated to the surgery. As a result, the bladder injury that occurred during the procedure is not reported.
  5. A patient dies during a surgical procedure, and there is no evidence of bladder injury. Therefore, the bladder injury is not reported.

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