How To Use HCPCS Code G9684

HCPCS code G9684 describes the onsite acute care treatment of a nursing facility resident for a urinary tract infection (UTI). This code can only be billed once per day per beneficiary. In this article, we will explore the details of HCPCS code G9684, 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 G9684?

HCPCS code G9684 is used to identify the onsite acute care treatment of a nursing facility resident for a urinary tract infection. It is important to note that this code can only be billed once per day per beneficiary. This code is specific to the treatment of UTIs in nursing facility residents and should not be used for other conditions or in different settings.

2. Official Description

The official description of HCPCS code G9684 is “Acute care urinary tract inf.” This short description provides a concise summary of the service or treatment being provided, which in this case is the acute care treatment of a urinary tract infection.

3. Procedure

  1. The provider begins by assessing the nursing facility resident’s symptoms and medical history to determine if a urinary tract infection is present.
  2. If a urinary tract infection is suspected, the provider may order laboratory tests, such as a urine culture, to confirm the diagnosis.
  3. Once the diagnosis is confirmed, the provider will prescribe appropriate antibiotics to treat the urinary tract infection.
  4. The provider will administer the prescribed antibiotics to the nursing facility resident onsite, ensuring proper dosage and administration.
  5. Throughout the treatment process, the provider will monitor the resident’s response to the antibiotics and make any necessary adjustments to the treatment plan.
  6. Additional supportive care, such as increased fluid intake or pain management, may also be provided as needed.
  7. Documentation of the treatment, including the diagnosis, prescribed medications, and any additional care provided, should be accurately recorded in the resident’s medical record.

4. When to use HCPCS code G9684

HCPCS code G9684 should be used when providing onsite acute care treatment for a urinary tract infection in a nursing facility resident. It is important to ensure that the service meets the specific criteria outlined in the code description, including being provided to a nursing facility resident and for the treatment of a urinary tract infection. If the service does not meet these criteria, a different HCPCS code should be used to accurately represent the provided service or treatment.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9684, healthcare providers should ensure that the necessary documentation is in place to support the service provided. This may include documentation of the diagnosis, prescribed medications, treatment plan, and any additional care provided. It is important to accurately code and bill for the service to ensure proper reimbursement. Providers should follow the specific billing guidelines and requirements set forth by Medicare or other insurance payers.

6. Historical Information and Code Maintenance

HCPCS code G9684 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 a nursing facility resident for a urinary tract infection.

7. Medicare and Insurance Coverage

HCPCS code G9684 falls under the coverage code C, which indicates that coverage is determined by carrier judgment. This means that Medicare or other insurance payers will make a determination on whether to cover the service based on their own guidelines and policies. The pricing indicator code for HCPCS code G9684 is 00, which indicates that the service is not separately priced by Part B. This means that the service is either not covered, bundled with other services, or used exclusively by Part A. The multiple pricing indicator code is 9, which means that the value for this code is not established. This may be due to the service not being priced separately by Part B or other reasons determined by Medicare or other insurance payers.

8. Examples

Here are five examples of when HCPCS code G9684 should be billed:

  1. A nursing facility resident presents with symptoms of a urinary tract infection. The provider diagnoses the infection and administers onsite acute care treatment, including the prescription of antibiotics.
  2. Following a positive urine culture, a nursing facility resident is diagnosed with a urinary tract infection. The provider provides onsite acute care treatment, monitoring the resident’s response to antibiotics and adjusting the treatment plan as needed.
  3. A nursing facility resident with a history of recurrent urinary tract infections develops symptoms indicative of another infection. The provider administers onsite acute care treatment, including the prescription of appropriate antibiotics.
  4. During a routine assessment, a nursing facility resident is found to have a urinary tract infection. The provider provides onsite acute care treatment, ensuring the resident receives the necessary antibiotics and supportive care.
  5. A nursing facility resident is transferred from a hospital with a urinary tract infection. The provider continues the onsite acute care treatment initiated in the hospital, monitoring the resident’s progress and adjusting the treatment plan as necessary.

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