HCPCS code G9703 describes episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date. This code is used to identify instances where a patient has been prescribed and has taken antibiotics within the 30-day period leading up to a specific episode of care. In this article, we will explore the details of HCPCS code G9703, 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 G9703?
HCPCS code G9703 is a specific code used in medical coding to identify episodes where the patient has taken antibiotics in the 30 days prior to the episode date. It helps healthcare providers and insurance companies track and analyze the use of antibiotics in patient care. By using this code, healthcare professionals can gain insights into the prevalence and impact of antibiotic usage on patient outcomes.
2. Official Description
The official description of HCPCS code G9703 is “Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date.” The short description for this code is “Anbx 30 prior to episode.” This description accurately reflects the purpose and usage of the code.
3. Procedure
- The healthcare provider should review the patient’s medical records to determine if the patient has been prescribed and has taken antibiotics within the 30-day period prior to the episode date.
- If the patient has taken antibiotics, the provider should document the specific antibiotics used and the duration of the antibiotic treatment.
- The provider should ensure that the documentation clearly indicates the start and end dates of the antibiotic treatment.
- The provider should assign HCPCS code G9703 to the episode to indicate the patient’s antibiotic usage within the specified timeframe.
4. When to use HCPCS code G9703
HCPCS code G9703 should be used in cases where the patient has been prescribed and has taken antibiotics within the 30 days prior to the episode date. It is important to note that this code is specific to episodes of care and should not be used for general antibiotic usage outside of the defined timeframe.
5. Billing Guidelines and Documentation Requirements
When billing for HCPCS code G9703, healthcare providers need to ensure that the patient’s medical records clearly document the antibiotic usage within the 30-day period prior to the episode date. The documentation should include the specific antibiotics used, the duration of the treatment, and the start and end dates of the antibiotic therapy. This information is crucial for accurate billing and reimbursement.
6. Historical Information and Code Maintenance
HCPCS code G9703 was added to the Healthcare Common Procedure Coding System on January 01, 2017. The code’s official description and short description have remained the same since its addition. As of January 01, 2024, there has been a change in the long description of the procedure or modifier code. No other maintenance actions have been taken for this code.
7. Medicare and Insurance Coverage
HCPCS code G9703 is covered by Medicare and other insurance providers. However, it is important to note that 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 is bundled or not covered separately. The multiple pricing indicator code for this code is 9, which means that the value is not established or not applicable as HCPCS is not priced separately by Part B.
8. Examples
Here are five examples of when HCPCS code G9703 should be billed:
- A patient is admitted to the hospital for a surgical procedure. The patient had been prescribed and had taken antibiotics for a urinary tract infection within the 30 days prior to the surgery.
- A patient visits an outpatient clinic for a follow-up appointment. The patient had been prescribed and had taken antibiotics for a respiratory infection within the 30 days prior to the appointment.
- A patient receives home healthcare services after being discharged from the hospital. The patient had been prescribed and had taken antibiotics for a skin infection within the 30 days prior to the start of home healthcare.
- A patient undergoes a diagnostic procedure at an imaging center. The patient had been prescribed and had taken antibiotics for a dental infection within the 30 days prior to the procedure.
- A patient receives physical therapy services for a musculoskeletal condition. The patient had been prescribed and had taken antibiotics for a joint infection within the 30 days prior to starting physical therapy.
