How To Use HCPCS Code G9695

HCPCS code G9695 describes a long-acting inhaled bronchodilator that is prescribed to patients. This code is used to identify and bill for the administration of a long-acting bronchodilator through inhalation. In this article, we will explore the details of HCPCS code G9695, 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 G9695?

HCPCS code G9695 is used to identify the administration of a long-acting inhaled bronchodilator that is prescribed to patients. This code specifically refers to the use of a long-acting bronchodilator through inhalation. It is important to note that this code is not applicable for other forms of bronchodilator administration, such as oral or intravenous.

2. Official Description

The official description of HCPCS code G9695 is “Long-acting inhaled bronchodilator prescribed.” The short description for this code is “Long act inhal bronchdil pre.” These descriptions accurately represent the purpose and usage of this specific code.

3. Procedure

  1. The provider begins by assessing the patient’s respiratory condition and determining the need for a long-acting bronchodilator.
  2. If it is determined that a long-acting bronchodilator is necessary, the provider prescribes the appropriate medication.
  3. The patient is instructed on how to properly use the inhaler device for the long-acting bronchodilator.
  4. The provider may demonstrate the correct technique for inhaler use and ensure that the patient understands the instructions.
  5. The patient then self-administers the long-acting bronchodilator through inhalation as prescribed by the provider.
  6. The provider may periodically assess the patient’s response to the medication and make any necessary adjustments to the treatment plan.

4. When to use HCPCS code G9695

HCPCS code G9695 should be used when a long-acting inhaled bronchodilator is prescribed to a patient. This code is specifically for the administration of a long-acting bronchodilator through inhalation. It is important to ensure that the patient meets the eligibility criteria for this type of medication and that it is medically necessary for their respiratory condition.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9695, healthcare providers need to document the prescription of the long-acting inhaled bronchodilator, including the specific medication prescribed and the dosage instructions. Additionally, documentation should include any assessments or evaluations performed to determine the need for the medication and the patient’s response to the treatment. It is important to follow the billing guidelines set forth by the payer, including any specific modifiers or additional documentation requirements.

6. Historical Information and Code Maintenance

HCPCS code G9695 was added to the Healthcare Common Procedure Coding System on January 01, 2017. 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 has remained unchanged since its inception.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G9695 may vary depending on the payer. Medicare coverage for this code is determined by the carrier’s judgment, as indicated by the coverage code C. It is important to verify coverage with the specific insurance provider and follow their guidelines for billing and reimbursement. 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 may be bundled or not covered by Medicare. The multiple pricing indicator code is 9, which means that the value for this code is not established. It is important to check with the payer for specific pricing information.

8. Examples

Here are five examples of when HCPCS code G9695 should be billed:

  1. A patient with chronic obstructive pulmonary disease (COPD) is prescribed a long-acting inhaled bronchodilator to manage their symptoms and improve lung function.
  2. A patient with asthma is prescribed a long-acting inhaled bronchodilator as part of their maintenance treatment plan to prevent asthma attacks.
  3. A patient with bronchiectasis is prescribed a long-acting inhaled bronchodilator to help open up their airways and improve breathing.
  4. A patient with cystic fibrosis is prescribed a long-acting inhaled bronchodilator to help clear mucus from their lungs and improve respiratory function.
  5. A patient with chronic bronchitis is prescribed a long-acting inhaled bronchodilator to alleviate symptoms such as coughing and shortness of breath.

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