How To Use HCPCS Code G9679

HCPCS code G9679 describes the onsite acute care treatment of a nursing facility resident with pneumonia. This code is used to identify and bill for the specific medical services provided to a nursing facility resident who is diagnosed with pneumonia and requires acute care treatment. It is important to note that this code may only be billed once per day per beneficiary.

1. What is HCPCS G9679?

HCPCS code G9679 is a specific code used in medical coding to identify and bill for the onsite acute care treatment of a nursing facility resident with pneumonia. This code is part of the Healthcare Common Procedure Coding System (HCPCS) and is used by healthcare providers to accurately document and report the services provided to patients.

2. Official Description

The official description of HCPCS code G9679 is “Acute care pneumonia.” This short description provides a concise summary of the medical condition or treatment associated with this code.

3. Procedure

  1. Upon diagnosing a nursing facility resident with pneumonia, the healthcare provider assesses the severity of the condition and determines the need for acute care treatment.
  2. The provider administers appropriate medications, such as antibiotics, to treat the infection and alleviate symptoms.
  3. Additional treatments, such as oxygen therapy or respiratory support, may be provided to ensure adequate oxygenation and respiratory function.
  4. The patient’s vital signs and clinical status are closely monitored throughout the acute care treatment.
  5. Any necessary laboratory tests, such as blood cultures or chest X-rays, are ordered and interpreted to aid in the diagnosis and management of the pneumonia.
  6. Once the acute care treatment is completed, the provider documents the services provided and submits the appropriate claim using HCPCS code G9679.

4. When to use HCPCS code G9679

HCPCS code G9679 should be used when a nursing facility resident is diagnosed with pneumonia and requires onsite acute care treatment. This code is specific to the treatment of pneumonia and should not be used for other medical conditions or treatments.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9679, healthcare providers should ensure that the documentation supports the medical necessity and appropriateness of the acute care treatment provided. This may include documenting the patient’s diagnosis of pneumonia, the severity of the condition, and the specific treatments administered. It is important to follow the billing guidelines and requirements set forth by the payer, such as Medicare or other insurance companies, to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9679 was added to the Healthcare Common Procedure Coding System on October 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 in use for the onsite acute care treatment of nursing facility residents with pneumonia.

7. Medicare and Insurance Coverage

HCPCS code G9679 is eligible for coverage and reimbursement by Medicare and other insurance companies. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service is bundled or not covered separately. The multiple pricing indicator code is 9, which indicates that the value for this code is not established. It is important for healthcare providers to verify the coverage and reimbursement policies of each payer to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G9679 should be billed:

  1. A nursing facility resident is diagnosed with pneumonia and requires acute care treatment, including administration of antibiotics and respiratory support.
  2. A nursing facility resident with a history of chronic lung disease develops pneumonia and requires onsite acute care treatment, including oxygen therapy and close monitoring of vital signs.
  3. A nursing facility resident with a compromised immune system develops pneumonia and requires immediate onsite acute care treatment, including intravenous antibiotics and frequent assessment of clinical status.
  4. A nursing facility resident with pneumonia experiences worsening symptoms and requires transfer to an acute care hospital for further evaluation and treatment.
  5. A nursing facility resident with pneumonia receives daily onsite acute care treatment, including medication administration and respiratory therapies, until the infection is resolved.

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