How To Use HCPCS Code G9685
HCPCS code G9685 describes a physician service or other qualified health care professional for the evaluation and management of a beneficiary’s acute change in condition in a nursing facility. This code is specifically used for a demonstration project and has certain coverage and pricing indicators associated with it.
1. What is HCPCS G9685?
HCPCS code G9685 is a specific code used to identify a physician service or other qualified health care professional for the evaluation and management of a beneficiary’s acute change in condition in a nursing facility. This code is used in the context of a demonstration project.
2. Official Description
The official description of HCPCS code G9685 is “Physician service or other qualified health care professional for the evaluation and management of a beneficiary’s acute change in condition in a nursing facility.” The short description for this code is “Acute nursing facility care.”
3. Procedure
- The provider begins by evaluating the beneficiary’s acute change in condition in a nursing facility.
- Based on the evaluation, the provider determines the appropriate management plan for the beneficiary.
- The provider then implements the necessary interventions and treatments to address the acute change in condition.
- Throughout the process, the provider closely monitors the beneficiary’s progress and adjusts the management plan as needed.
4. When to use HCPCS code G9685
HCPCS code G9685 should be used when a physician or other qualified health care professional is providing evaluation and management services for a beneficiary’s acute change in condition in a nursing facility. It is important to note that this code is specifically used for a demonstration project.
5. Billing Guidelines and Documentation Requirements
When billing for HCPCS code G9685, healthcare providers need to ensure that the documentation supports the evaluation and management of the beneficiary’s acute change in condition in a nursing facility. This includes documenting the specific services provided, the medical necessity of the services, and any relevant clinical findings or observations.
6. Historical Information and Code Maintenance
HCPCS code G9685 was added to the Healthcare Common Procedure Coding System on October 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.
7. Medicare and Insurance Coverage
The coverage for HCPCS code G9685 is determined by carrier judgment, indicated by the coverage code C. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. It is important for healthcare providers to check with Medicare or other insurers to determine the specific coverage and pricing for this code.
8. Examples
Here are five examples of when HCPCS code G9685 should be billed:
- A physician evaluates and manages a beneficiary’s acute change in condition, such as a sudden onset of respiratory distress, in a nursing facility as part of the demonstration project.
- A qualified health care professional provides evaluation and management services for a beneficiary who experiences a significant decline in cognitive function in a nursing facility covered by the demonstration project.
- A physician assesses and treats a beneficiary’s acute infection in a nursing facility as part of the demonstration project.
- A qualified health care professional evaluates and manages a beneficiary’s acute exacerbation of a chronic condition, such as heart failure, in a nursing facility covered by the demonstration project.
- A physician provides evaluation and management services for a beneficiary who experiences a sudden change in mobility in a nursing facility as part of the demonstration project.
