How To Use HCPCS Code G9698

HCPCS code G9698 describes the documentation of system reasons for not prescribing a long-acting inhaled bronchodilator. This code is used to indicate the specific reasons why a healthcare provider did not prescribe a long-acting inhaled bronchodilator to a patient. It provides valuable information for medical coders and insurance companies to understand the rationale behind the treatment decisions made by healthcare providers.

1. What is HCPCS G9698?

HCPCS code G9698 is a specific code used in medical coding to identify the documentation of system reasons for not prescribing a long-acting inhaled bronchodilator. It is important to note that this code does not represent the actual procedure or treatment itself, but rather the documentation of the reasons why a long-acting inhaled bronchodilator was not prescribed.

2. Official Description

The official description of HCPCS code G9698 is “Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance)”. The short description for this code is “Sys rsn no presc bronchdil”.

3. Procedure

  1. The healthcare provider should thoroughly document the specific system reasons for not prescribing a long-acting inhaled bronchodilator.
  2. Examples of system reasons may include the cost of treatment, lack of insurance coverage, or any other relevant factors that influenced the decision not to prescribe the medication.
  3. It is important for the documentation to be clear, concise, and accurately reflect the reasons behind the treatment decision.

4. When to use HCPCS code G9698

HCPCS code G9698 should be used when a healthcare provider has made a conscious decision not to prescribe a long-acting inhaled bronchodilator to a patient and has documented the specific system reasons for this decision. It is important to note that this code should only be used when the provider has considered the use of a long-acting inhaled bronchodilator and has made a deliberate decision not to prescribe it.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9698, healthcare providers need to ensure that the documentation clearly supports the system reasons for not prescribing a long-acting inhaled bronchodilator. The documentation should include specific details about the factors that influenced the decision, such as the cost of treatment or lack of insurance coverage. It is important to accurately reflect the provider’s thought process and reasoning behind the decision in the medical record.

6. Historical Information and Code Maintenance

HCPCS code G9698 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of January 01, 2024, there has been a change in the long description of the procedure or modifier code. This code is not separately priced by Part B and has a pricing indicator code of 00, which means it is not covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, indicating that the value is not established or applicable for separate pricing by Part B.

7. Medicare and Insurance Coverage

HCPCS code G9698 is covered by Medicare and other insurance providers. However, it is important to note that this code represents the documentation of system reasons for not prescribing a long-acting inhaled bronchodilator and not the actual treatment itself. The coverage and reimbursement for the specific treatment or medication would depend on the individual insurance plan and its policies.

8. Examples

Here are some examples of when HCPCS code G9698 should be billed:

  1. A patient with a documented history of adverse reactions to long-acting inhaled bronchodilators.
  2. A patient who cannot afford the cost of the prescribed long-acting inhaled bronchodilator.
  3. A patient who does not have insurance coverage for long-acting inhaled bronchodilators.
  4. A patient who has been prescribed alternative treatments for their respiratory condition.
  5. A patient who has a contraindication for the use of long-acting inhaled bronchodilators.

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