How To Use HCPCS Code G9648

HCPCS code G9648 describes patients with a 90-day Modified Rankin Scale (MRS) score greater than 2. This code is used to identify patients who have a significant level of disability and require ongoing medical care and support. In this article, we will explore the details of HCPCS code G9648, including its official description, procedure, when to use it, billing guidelines and documentation requirements, historical information and code maintenance, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9648?

HCPCS code G9648 is used to identify patients with a 90-day MRS score greater than 2. The MRS is a scale used to measure the level of disability in patients who have experienced a stroke or other neurological conditions. A score greater than 2 indicates a significant level of disability, requiring ongoing medical care and support.

2. Official Description

The official description of HCPCS code G9648 is “Patients with 90-day MRS score greater than 2.” The short description is “Pt w/90d mrs >2.”

3. Procedure

1. Assess the patient’s MRS score to determine if it is greater than 2.
2. If the patient’s MRS score is greater than 2, document the score and proceed with providing the necessary medical care and support.
3. Continue to monitor the patient’s progress and adjust the treatment plan as needed.

4. When to use HCPCS code G9648

HCPCS code G9648 should be used when a patient has a 90-day MRS score greater than 2. This indicates that the patient has a significant level of disability and requires ongoing medical care and support. It is important to accurately document the patient’s MRS score and ensure that the code is used appropriately.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9648, healthcare providers need to document the patient’s 90-day MRS score and provide supporting documentation to justify the use of this code. It is important to accurately capture the patient’s level of disability and the need for ongoing medical care and support. Proper documentation will help ensure accurate reimbursement and prevent any potential audit issues.

6. Historical Information and Code Maintenance

HCPCS code G9648 was added to the Healthcare Common Procedure Coding System on January 01, 2016. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code remains relevant for identifying patients with a 90-day MRS score greater than 2.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G9648 may vary depending on the payer. Medicare and other insurance providers may have specific guidelines and criteria for reimbursement. It is important to review the payer’s policies and guidelines to determine if this code is payable and to ensure proper reimbursement. The pricing indicator code for HCPCS code G9648 is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value is not established or applicable as HCPCS is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9648 should be billed:

1. A patient who has experienced a stroke and has a 90-day MRS score of 3, indicating a moderate level of disability.
2. A patient with a neurological condition who requires ongoing medical care and support due to a 90-day MRS score of 4, indicating a severe level of disability.
3. A patient who has undergone a brain surgery and has a 90-day MRS score of 2, indicating a mild level of disability but still requiring ongoing medical care.
4. A patient with a spinal cord injury who has a 90-day MRS score of 5, indicating a very severe level of disability and the need for extensive medical care and support.
5. A patient with a progressive neurological disease who has a 90-day MRS score of 3, indicating a moderate level of disability and the need for ongoing medical management.