How To Use HCPCS Code G9650

HCPCS code G9650 describes the documentation that the patient declined therapy change or has documented contraindications in order to achieve better disease control. This code is used to indicate that the patient has experienced adverse effects or lack of efficacy with all other therapy options, and therefore, a therapy change is not recommended or contraindicated. The purpose of using this code is to measure disease control based on various assessment tools such as the Patient Global Assessment (PGA), Body Surface Area (BSA), Psoriasis Area and Severity Index (PASI), or Dermatology Life Quality Index (DLQI).

1. What is HCPCS G9650?

HCPCS code G9650 is a specific code used in medical coding to identify the documentation that the patient declined therapy change or has documented contraindications. It signifies that the patient has experienced adverse effects or lack of efficacy with all other therapy options, and as a result, a therapy change is not recommended or contraindicated. This code is used to measure disease control based on specific assessment tools.

2. Official Description

The official description of HCPCS code G9650 is “Documentation that the patient declined therapy change or has documented contraindications (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by PGA, BSA, PASI, or DLQI.” The short description for this code is “Doc pt no ther chg or contra.”

3. Procedure

  1. The healthcare provider should thoroughly document the patient’s decision to decline therapy change or the presence of documented contraindications.
  2. The provider should clearly state the reasons for the patient’s decision, such as adverse effects experienced with previous therapies or lack of efficacy.
  3. The documentation should include the specific assessment tools used to measure disease control, such as PGA, BSA, PASI, or DLQI.
  4. It is important for the provider to accurately record the patient’s condition and the impact of the therapy change or contraindications on disease control.

4. When to use HCPCS code G9650

HCPCS code G9650 should be used when the patient has declined therapy change or has documented contraindications. This code is applicable when the patient has experienced adverse effects or lack of efficacy with all other therapy options, and a therapy change is not recommended or contraindicated. The use of this code helps in measuring disease control based on specific assessment tools.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9650, healthcare providers need to ensure proper documentation. The documentation should clearly state the patient’s decision to decline therapy change or the presence of documented contraindications. It should include the reasons for the patient’s decision, such as adverse effects or lack of efficacy with previous therapies. Additionally, the documentation should mention the specific assessment tools used to measure disease control, such as PGA, BSA, PASI, or DLQI.

6. Historical Information and Code Maintenance

HCPCS code G9650 was added to the Healthcare Common Procedure Coding System on January 01, 2016. It has an effective date of January 01, 2017. As of December 31, 2016, this code was terminated. No maintenance actions have been 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 G9650 may vary. It is important to check with the specific payer for coverage and reimbursement guidelines. 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, indicating that the value is not established or the code is not priced separately by Part B.

8. Examples

Here are some examples of when HCPCS code G9650 should be billed:

  1. A patient with psoriasis who has tried multiple therapies with no improvement and has documented contraindications to other treatment options.
  2. A patient with a chronic condition who has experienced adverse effects with all available therapies and has decided to continue with the current treatment plan.
  3. A patient with a skin condition who has declined therapy change due to lack of efficacy with previous treatments.
  4. A patient with a dermatological condition who has documented contraindications to alternative therapies and has chosen to maintain the current treatment.
  5. A patient with a chronic disease who has experienced adverse effects with all other therapy options and has decided to continue with the current treatment plan for better disease control.

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