How To Use HCPCS Code G9634

HCPCS code G9634 describes the assessment of health-related quality of life using a specific tool during at least two visits, where the quality of life score remains the same or improves. This code is used to identify and bill for the evaluation of a patient’s overall well-being and the impact of medical interventions on their quality of life.

1. What is HCPCS G9634?

HCPCS code G9634 is a specific code used in medical coding to identify and bill for the assessment of health-related quality of life using a designated tool. This code is used when a healthcare provider evaluates a patient’s overall well-being and the impact of medical interventions on their quality of life. It is important to note that this code is only applicable when the assessment is conducted during at least two visits and the quality of life score remains the same or improves.

2. Official Description

The official description of HCPCS code G9634 is “Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved.” The short description for this code is “Qual life tool 2x same/impr.”

3. Procedure

  1. The healthcare provider begins by selecting the appropriate tool for assessing health-related quality of life.
  2. During at least two visits, the provider administers the chosen tool to the patient.
  3. The provider records the quality of life score obtained from each assessment.
  4. If the quality of life score remains the same or improves between the visits, the provider can use HCPCS code G9634 to bill for the assessment.

4. When to use HCPCS code G9634

HCPCS code G9634 should be used when a healthcare provider assesses a patient’s health-related quality of life using a designated tool during at least two visits. It is important to note that the quality of life score must remain the same or improve for this code to be applicable. This code is typically used to evaluate the impact of medical interventions on a patient’s overall well-being and to monitor any changes in their quality of life over time.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9634, healthcare providers need to ensure that the following documentation requirements are met:

  • Documentation of the tool used for assessing health-related quality of life.
  • Documentation of at least two visits where the assessment was conducted.
  • Documentation of the quality of life scores obtained during each visit.
  • Documentation indicating that the quality of life score remained the same or improved between the visits.

6. Historical Information and Code Maintenance

HCPCS code G9634 was added to the Healthcare Common Procedure Coding System on January 01, 2016. As of December 31, 2021, this code has been terminated and is no longer valid for use. The termination of this code means that it is no longer recognized or reimbursed by Medicare or other insurance providers. It is important for medical coders to be aware of the termination date and use alternative codes, if applicable.

7. Medicare and Insurance Coverage

HCPCS code G9634 is classified under the HCPCS Coverage Code C, which indicates that coverage is determined by carrier judgment. This means that Medicare or other insurance providers will make a decision on whether to cover and reimburse for this code based on their own policies and guidelines. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B and may be bundled or not covered by Medicare. It is important for healthcare providers to check with the specific insurance carrier for coverage and reimbursement details.

8. Examples

Here are five examples of scenarios where HCPCS code G9634 may be used:

  1. A patient with a chronic illness undergoes a series of medical interventions over a period of six months. The healthcare provider assesses the patient’s health-related quality of life using a designated tool during three visits. The quality of life score remains the same throughout the visits. HCPCS code G9634 can be used to bill for the assessments.
  2. A patient undergoes a surgical procedure and is followed up by the healthcare provider at one-month intervals for a period of three months. During each visit, the provider administers a tool to assess the patient’s health-related quality of life. The quality of life score improves between each visit. HCPCS code G9634 can be used to bill for the assessments.
  3. A patient with a mental health condition receives counseling sessions from a healthcare provider. The provider conducts an assessment of the patient’s health-related quality of life using a designated tool during the initial visit and a follow-up visit three months later. The quality of life score remains the same between the visits. HCPCS code G9634 can be used to bill for the assessments.
  4. A patient with a chronic pain condition undergoes a series of physical therapy sessions. The healthcare provider assesses the patient’s health-related quality of life using a designated tool during the initial visit and a follow-up visit six weeks later. The quality of life score improves between the visits. HCPCS code G9634 can be used to bill for the assessments.
  5. A patient participates in a clinical trial for a new medication. The healthcare provider assesses the patient’s health-related quality of life using a designated tool during the baseline visit and at three-month intervals for a period of one year. The quality of life score remains the same throughout the visits. HCPCS code G9634 can be used to bill for the assessments.

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