HCPCS code G9636 describes a specific scenario in which the health-related quality of life of a patient has not been assessed using a tool during at least two visits, or the quality of life score has declined. This code is used to indicate that the healthcare provider has not conducted a formal assessment of the patient’s quality of life or that there has been a decline in the patient’s quality of life score.
1. What is HCPCS G9636?
HCPCS code G9636 is a specific code used in medical coding to identify the situation where the health-related quality of life of a patient has not been assessed using a tool during at least two visits, or the quality of life score has declined. This code is important for accurately documenting and billing for the services provided to the patient.
2. Official Description
The official description of HCPCS code G9636 is “Health-related quality of life not assessed with tool during at least two visits or quality of life score declined.” The short description for this code is “No life asst 2x same/decr.”
3. Procedure
- The healthcare provider should document the patient’s visits and assessments accurately.
- If the provider has not used a specific tool to assess the patient’s health-related quality of life during at least two visits, or if the quality of life score has declined, the code G9636 should be assigned.
- Ensure that the documentation clearly supports the use of this code and provides sufficient details about the patient’s condition.
4. When to use HCPCS code G9636
HCPCS code G9636 should be used in situations where the health-related quality of life of a patient has not been assessed using a tool during at least two visits, or if the quality of life score has declined. It is important to accurately document and code this information to ensure proper billing and reimbursement.
5. Billing Guidelines and Documentation Requirements
When using HCPCS code G9636, healthcare providers need to ensure that the documentation supports the lack of assessment or decline in quality of life score. This may include detailed notes about the patient’s condition, any relevant tests or assessments performed, and the provider’s clinical judgment regarding the patient’s quality of life. Proper documentation is crucial for accurate billing and reimbursement.
6. Historical Information and Code Maintenance
HCPCS code G9636 was added to the Healthcare Common Procedure Coding System on January 1, 2016. It has a termination date of December 31, 2021. As of January 1, 2022, there is no maintenance 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 the code.
7. Medicare and Insurance Coverage
Medicare and other insurance providers may have specific coverage policies for HCPCS code G9636. It is important to review the pricing indicator code and multiple pricing indicator code to understand how the service or supply is priced by Medicare or other insurers. This code may be subject to specific coverage criteria and reimbursement guidelines.
8. Examples
Here are five examples of scenarios where HCPCS code G9636 should be billed:
- A patient visits a healthcare provider twice, but no formal assessment of their quality of life is conducted during these visits.
- A patient’s quality of life score declines during a series of visits, indicating a worsening of their overall well-being.
- A healthcare provider determines that a formal assessment of the patient’s quality of life is not necessary based on their clinical judgment.
- A patient’s quality of life score remains the same during multiple visits, indicating a stable condition.
- A healthcare provider determines that a decline in the patient’s quality of life score is not significant enough to warrant further assessment or intervention.
