How To Use HCPCS Code G9690

HCPCS code G9690 describes a patient receiving hospice services at any time during the measurement period. This code is used to identify and track patients who are receiving hospice care, which is a specialized form of medical care provided to individuals who are terminally ill and have a life expectancy of six months or less. Hospice services focus on providing comfort and support to patients and their families, rather than attempting to cure the underlying illness.

1. What is HCPCS G9690?

HCPCS code G9690 is a specific code used in medical coding to indicate that a patient is receiving hospice services. It is important for medical coders to accurately assign this code to ensure proper documentation and billing for the services provided to the patient.

2. Official Description

The official description of HCPCS code G9690 is “Patient receiving hospice services any time during the measurement period.” The short description for this code is “Pt in hos.”

3. Procedure

  1. When assigning HCPCS code G9690, the medical coder should review the patient’s medical records to confirm that they are receiving hospice services.
  2. The coder should ensure that the patient meets the eligibility criteria for hospice care, such as having a terminal illness with a life expectancy of six months or less.
  3. If the patient is receiving hospice services, the coder should assign HCPCS code G9690 to accurately reflect this in the medical coding.

4. When to use HCPCS code G9690

HCPCS code G9690 should be used when a patient is receiving hospice services at any time during the measurement period. It is important to note that this code is specific to hospice care and should not be used for other types of medical services or treatments.

5. Billing Guidelines and Documentation Requirements

When billing for services associated with HCPCS code G9690, healthcare providers should ensure that the necessary documentation is in place to support the claim. This may include documentation of the patient’s terminal illness, the expected life expectancy, and the specific hospice services provided.

6. Historical Information and Code Maintenance

HCPCS code G9690 was added to the Healthcare Common Procedure Coding System on January 1, 2017. As of January 1, 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

Medicare and other insurance providers may cover hospice services for eligible patients. However, the specific coverage and reimbursement policies may vary. It is important for healthcare providers to review the guidelines and requirements of each payer to ensure proper billing and reimbursement for services associated with HCPCS code G9690.

8. Examples

Here are five examples of when HCPCS code G9690 should be billed:

  1. A patient with a terminal illness is admitted to a hospice program and receives ongoing care and support from a multidisciplinary team.
  2. A patient with a life expectancy of six months or less is receiving pain management and symptom control services through a hospice provider.
  3. A patient’s family receives bereavement counseling and support services from a hospice organization following the death of their loved one.
  4. A patient with a terminal illness receives respite care services through a hospice program, allowing their primary caregiver to take a temporary break from caregiving responsibilities.
  5. A patient’s medical equipment and supplies, such as a hospital bed or oxygen, are provided by a hospice organization to ensure their comfort and well-being during the end-of-life period.

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