How To Use HCPCS Code G9651

HCPCS code G9651 describes the assessment tool for psoriasis that is documented as not meeting any of the specified benchmarks. This code is used when the psoriasis assessment tool, such as the 5-point or 6-point scale (pga), body surface area (bsa), psoriasis area and severity index (pasi), and/or dermatology life quality index (dlqi), is not documented or does not meet the specified criteria. In this article, we will explore the details of HCPCS code G9651, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9651?

HCPCS code G9651 is used to identify cases where the assessment tool for psoriasis is documented as not meeting any of the specified benchmarks. This code is specific to psoriasis and is used to indicate that the assessment tool, such as the pga, bsa, pasi, and/or dlqi, is either not documented or does not meet the required criteria.

2. Official Description

The official description of HCPCS code G9651 is “Psoriasis assessment tool documented not 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)) or psoriasis assessment tool not documented.” The short description for this code is “Psor as doc no spc bm.”

3. Procedure

1. The healthcare provider should assess the patient’s psoriasis using the specified benchmarks, such as the pga, bsa, pasi, and/or dlqi.
2. If the assessment tool is documented, the provider should ensure that it meets the required criteria for each benchmark.
3. If the assessment tool does not meet any of the specified benchmarks or is not documented at all, HCPCS code G9651 should be used to indicate this.

4. When to use HCPCS code G9651

HCPCS code G9651 should be used when the assessment tool for psoriasis is not documented or does not meet any of the specified benchmarks. This code is applicable when the pga, bsa, pasi, and/or dlqi are not documented or do not meet the required criteria. It is important to accurately document and code this information to ensure proper reimbursement and tracking of psoriasis assessments.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9651, healthcare providers should ensure that the assessment tool for psoriasis is properly documented. This documentation should include the specific benchmarks used, such as the pga, bsa, pasi, and/or dlqi, and the results of the assessment. It is important to accurately capture and report this information to support the medical necessity of the assessment and ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9651 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. It is important to stay updated with any changes or revisions to HCPCS codes to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

HCPCS code G9651 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the service is bundled or not covered separately. The multiple pricing indicator code is 9, which means that the value is not established or not applicable. It is important to review the specific guidelines and policies of Medicare and other insurance providers to understand how this code is priced and reimbursed.

8. Examples

Here are some examples of when HCPCS code G9651 should be billed:

1. A patient with psoriasis visits a dermatologist for an assessment. The dermatologist documents the assessment tool but does not include the results for the pga, bsa, pasi, or dlqi. In this case, HCPCS code G9651 should be used to indicate that the assessment tool is documented but does not meet the specified benchmarks.
2. A patient with psoriasis visits a primary care physician for an assessment. The physician does not document any assessment tool for psoriasis. In this case, HCPCS code G9651 should be used to indicate that the assessment tool is not documented.
3. A patient with psoriasis visits a dermatologist for an assessment. The dermatologist documents the assessment tool and includes the results for the pga, bsa, pasi, and dlqi. The results show that the assessment tool meets the specified benchmarks. In this case, HCPCS code G9651 would not be used as the assessment tool meets the required criteria.