How To Use HCPCS Code G9631

HCPCS code G9631 describes a specific situation where a patient sustains a ureter injury either during surgery or within 30 days post-surgery. This code is used to identify and document cases where a ureter injury occurs and requires medical attention. In this article, we will explore the details of HCPCS code G9631, 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 G9631?

HCPCS code G9631 is a specific code used to identify cases where a patient sustains a ureter injury during surgery or within 30 days post-surgery. This code helps healthcare providers accurately document and track these types of injuries for billing and reporting purposes.

2. Official Description

The official description of HCPCS code G9631 is “Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery.” The short description for this code is “Pt ui srg 30 day pst srg.”

3. Procedure

1. The procedure for HCPCS code G9631 involves identifying and documenting cases where a patient sustains a ureter injury during surgery or within 30 days post-surgery.
2. The healthcare provider should thoroughly assess the patient’s medical records, surgical notes, and any post-operative findings to determine if a ureter injury has occurred.
3. If a ureter injury is identified, the provider should document the details of the injury, including the location, severity, and any necessary treatment or interventions.
4. It is important to accurately code and document the ureter injury using HCPCS code G9631 to ensure proper billing and reporting.

4. When to use HCPCS code G9631

HCPCS code G9631 should be used in cases where a patient sustains a ureter injury during surgery or within 30 days post-surgery. This code is specifically for documenting and billing purposes related to ureter injuries and should only be used when this specific situation occurs.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9631, healthcare providers should ensure the following documentation requirements are met:

• Accurate and detailed documentation of the ureter injury, including the location, severity, and any necessary treatment or interventions.
• Supporting medical records, surgical notes, and post-operative findings that clearly indicate the occurrence of a ureter injury.
• Proper coding of HCPCS code G9631 on the claim form to indicate the specific ureter injury.

6. Historical Information and Code Maintenance

HCPCS code G9631 was added to the Healthcare Common Procedure Coding System on January 01, 2016. It is important to note that this code is terminated as of December 31, 2022. The termination date indicates that this code is no longer valid for use after that date.

7. Medicare and Insurance Coverage

HCPCS code G9631 falls under the coverage code C, which means it is subject to carrier judgment for Medicare coverage. The pricing indicator code for this code is 00, indicating that it is not separately priced by Part B. This means that the service associated with this code may be bundled or not covered by Medicare. It is important to check with Medicare and other insurance providers for specific coverage and reimbursement guidelines.

8. Examples

Here are five examples of when HCPCS code G9631 should be billed:

1. A patient undergoes abdominal surgery and sustains a ureter injury during the procedure. HCPCS code G9631 should be used to document and bill for this specific injury.
2. A patient presents with post-operative complications, and a ureter injury is discovered within 30 days post-surgery. HCPCS code G9631 should be used to document and bill for the injury.
3. During a routine follow-up appointment after surgery, a patient complains of urinary symptoms, and further examination reveals a ureter injury. HCPCS code G9631 should be used to document and bill for the injury.
4. A patient undergoes a surgical procedure, and during the operation, a ureter injury is identified and repaired. HCPCS code G9631 should be used to document and bill for the injury and subsequent repair.
5. A patient presents with symptoms of a possible ureter injury, and diagnostic tests confirm the presence of an injury within 30 days post-surgery. HCPCS code G9631 should be used to document and bill for the injury.