How To Use HCPCS Code G9649

HCPCS code G9649 describes the assessment tool used to evaluate psoriasis and determine if it meets specific benchmarks. This code is used to document the assessment of psoriasis using various scales such as the Psoriasis Area and Severity Index (PASI), the Dermatology Life Quality Index (DLQI), the body surface area (BSA), or the Physician Global Assessment (PGA). The purpose of this article is to provide a comprehensive understanding of HCPCS code G9649, including its official description, procedure, when to use it, billing guidelines, historical information, and Medicare and insurance coverage.

1. What is HCPCS G9649?

HCPCS code G9649 is used to identify the assessment tool documented for psoriasis that meets any one of the specified benchmarks. The assessment can be done using various scales such as the 5-point or 6-point scale of the Physician Global Assessment (PGA), the body surface area (BSA), the Psoriasis Area and Severity Index (PASI), or the Dermatology Life Quality Index (DLQI). This code is essential for accurately documenting the assessment of psoriasis and ensuring appropriate reimbursement for the healthcare provider.

2. Official Description

The official description of HCPCS code G9649 is “Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)).” The short description for this code is “Psor as doc spc bm.”

3. Procedure

  1. The healthcare provider should administer the assessment tool to evaluate the severity and impact of psoriasis on the patient.
  2. Depending on the specific benchmark chosen, the provider will document the results of the assessment using the appropriate scale, such as the PGA, BSA, PASI, or DLQI.
  3. The documentation should accurately reflect the patient’s condition and the specific benchmark met.
  4. The assessment tool should be administered and documented at the appropriate intervals based on the patient’s treatment plan and the severity of their psoriasis.

4. When to use HCPCS code G9649

HCPCS code G9649 should be used when the healthcare provider performs an assessment of psoriasis using any one of the specified benchmarks, including the PGA, BSA, PASI, or DLQI. It is important to use this code when documenting the assessment to ensure accurate billing and reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9649, healthcare providers should ensure that the assessment tool used meets one of the specified benchmarks. The documentation should clearly indicate the benchmark used and the results of the assessment. It is important to accurately document the severity and impact of psoriasis to support the medical necessity of the assessment.

6. Historical Information and Code Maintenance

HCPCS code G9649 was added to the Healthcare Common Procedure Coding System on January 01, 2016. As of January 01, 2019, 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 is used to accurately document the assessment of psoriasis and ensure appropriate reimbursement for healthcare providers.

7. Medicare and Insurance Coverage

HCPCS code G9649 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means it is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that it is not applicable as HCPCS G9649 is not priced separately by Part B. The service or supply associated with this code is bundled or not covered by Medicare. However, it is important to check with individual insurance providers for specific coverage and reimbursement policies.

8. Examples

Here are five examples of when HCPCS code G9649 should be billed:

  1. A dermatologist assesses a patient’s psoriasis severity using the Psoriasis Area and Severity Index (PASI) and documents the results using HCPCS code G9649.
  2. A rheumatologist evaluates a patient’s psoriasis using the Physician Global Assessment (PGA) scale and documents the assessment using HCPCS code G9649.
  3. A primary care physician measures the body surface area (BSA) affected by psoriasis and documents the assessment using HCPCS code G9649.
  4. A dermatologist uses the Dermatology Life Quality Index (DLQI) to assess the impact of psoriasis on a patient’s quality of life and documents the assessment using HCPCS code G9649.
  5. A healthcare provider administers an assessment tool that combines multiple benchmarks, such as the PGA, BSA, and PASI, to evaluate the severity and impact of psoriasis and documents the assessment using HCPCS code G9649.

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