How To Use HCPCS Code G9701

HCPCS code G9701 describes the use of antibiotics in children within the 30 days prior to the date of the encounter during which the diagnosis was established. This code is used to identify and track cases where children have been prescribed antibiotics before their diagnosis, providing valuable information for medical coding and billing purposes.

1. What is HCPCS G9701?

HCPCS code G9701 is a specific code used in medical coding to indicate that a child has been prescribed antibiotics within the 30 days prior to the date of the encounter where the diagnosis was established. It helps healthcare providers and insurance companies track and analyze the use of antibiotics in pediatric patients.

2. Official Description

The official description of HCPCS code G9701 is “Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established.” The short description for this code is “Child anbx 30 prior dx estab.”

3. Procedure

  1. The healthcare provider reviews the patient’s medical history and notes any recent antibiotic prescriptions.
  2. If the child has been prescribed antibiotics within the 30 days prior to the encounter, the provider documents this information.
  3. The provider establishes the diagnosis based on the patient’s symptoms, medical history, and any additional diagnostic tests.
  4. The encounter is coded using HCPCS code G9701 to indicate that the child has been taking antibiotics prior to the diagnosis.

4. When to use HCPCS code G9701

HCPCS code G9701 should be used when a child has been prescribed antibiotics within the 30 days prior to the encounter where the diagnosis was established. It is important to accurately document and code this information to ensure proper tracking and analysis of antibiotic usage in pediatric patients.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9701, healthcare providers need to document the following:

  • The name and dosage of the antibiotic prescribed
  • The start and end dates of the antibiotic treatment
  • The date of the encounter where the diagnosis was established

These details are necessary for accurate billing and reimbursement purposes.

6. Historical Information and Code Maintenance

HCPCS code G9701 was added to the Healthcare Common Procedure Coding System on January 01, 2017. It has an effective date of January 01, 2021. As of December 31, 2020, this code has been terminated and is no longer in use. The termination of this code indicates that it is no longer necessary for tracking antibiotic usage in pediatric patients.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may have specific coverage policies for HCPCS code G9701. 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 pricing is not established. It is important to check with individual insurance providers for their coverage policies and reimbursement rates for this code.

8. Examples

Here are five examples of when HCPCS code G9701 should be billed:

  1. A 6-year-old child visits the pediatrician with symptoms of a respiratory infection. The provider notes that the child has been prescribed antibiotics for a similar condition within the past month. HCPCS code G9701 is used to indicate the prior antibiotic usage.
  2. A 10-year-old child is diagnosed with a urinary tract infection. The provider reviews the child’s medical history and finds that the child has been taking antibiotics for another condition in the past 30 days. HCPCS code G9701 is used to document the prior antibiotic usage.
  3. A 4-year-old child presents with symptoms of an ear infection. The provider discovers that the child has been on antibiotics for a different infection in the previous month. HCPCS code G9701 is used to indicate the prior antibiotic usage.
  4. A 7-year-old child is diagnosed with strep throat. The provider reviews the child’s medical records and finds that the child has been prescribed antibiotics for a different illness in the past 30 days. HCPCS code G9701 is used to document the prior antibiotic usage.
  5. A 5-year-old child visits the emergency room with symptoms of a skin infection. The provider notes that the child has been taking antibiotics for a different condition in the past month. HCPCS code G9701 is used to indicate the prior antibiotic usage.

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