HCPCS code G9635 describes the situation where health-related quality of life is not assessed using a tool for documented reasons. This code is used when a patient has a cognitive or neuropsychiatric impairment that impairs their ability to complete the HRQOL survey, or when a patient has an inability to read and/or write, making it impossible for them to complete the HRQOL questionnaire.
1. What is HCPCS G9635?
HCPCS code G9635 is a specific code used in medical coding to identify the situation where health-related quality of life is not assessed using a tool for documented reasons. It is important for medical coders to accurately assign this code to ensure proper billing and reimbursement.
2. Official Description
The official description of HCPCS code G9635 is “Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the HRQOL survey, patient has the inability to read and/or write in order to complete the HRQOL questionnaire).” The short description for this code is “No doc rsn do qual life assm.”
3. Procedure
- The healthcare provider should assess the patient’s ability to complete the health-related quality of life (HRQOL) survey or questionnaire.
- If the patient has a cognitive or neuropsychiatric impairment that impairs their ability to complete the survey, or if they have an inability to read and/or write, the provider should document these reasons.
- The provider should use HCPCS code G9635 to indicate that health-related quality of life was not assessed due to these documented reasons.
4. When to use HCPCS code G9635
HCPCS code G9635 should be used when health-related quality of life is not assessed using a tool for documented reasons. This includes situations where the patient has a cognitive or neuropsychiatric impairment that impairs their ability to complete the HRQOL survey, or when the patient has an inability to read and/or write, making it impossible for them to complete the HRQOL questionnaire.
5. Billing Guidelines and Documentation Requirements
When using HCPCS code G9635, healthcare providers should ensure proper documentation of the reasons why health-related quality of life was not assessed using a tool. This may include documentation of the patient’s cognitive or neuropsychiatric impairment or their inability to read and/or write. Proper documentation is essential for accurate billing and reimbursement.
6. Historical Information and Code Maintenance
HCPCS code G9635 was added to the Healthcare Common Procedure Coding System on January 1, 2016. It has a termination date of December 31, 2021. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.
7. Medicare and Insurance Coverage
Medicare and other insurance coverage for HCPCS code G9635 may vary. It is important for healthcare providers to check with the specific payer to determine if this code is payable. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. The multiple pricing indicator code is 9, which indicates that the code is not applicable as HCPCS is not priced separately by Part B or the value is not established.
8. Examples
Here are five examples of when HCPCS code G9635 should be billed:
- A patient with a cognitive impairment that prevents them from completing the HRQOL survey.
- A patient with a neuropsychiatric impairment that impairs their ability to complete the HRQOL survey.
- A patient who is unable to read and/or write, making it impossible for them to complete the HRQOL questionnaire.
- A patient with both a cognitive impairment and an inability to read and/or write.
- A patient with a neuropsychiatric impairment and an inability to read and/or write.
