How To Use HCPCS Code G9716

HCPCS code G9716 describes a specific scenario where the Body Mass Index (BMI) of a patient is documented as being outside of normal parameters, and the follow-up plan is not completed for a documented medical reason. This code is used to indicate that the provider has identified an abnormal BMI and has recommended a follow-up plan, but the plan was not carried out due to a valid medical reason.

1. What is HCPCS G9716?

HCPCS code G9716 is a specific code used in medical coding to identify cases where the BMI of a patient is outside of normal parameters, and the follow-up plan is not completed for a documented medical reason. It is important to note that this code is only applicable when there is a valid medical reason for not completing the follow-up plan.

2. Official Description

The official description of HCPCS code G9716 is “BMI is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason.” The short description for this code is “BMI doc onl fup not cmpltd.”

3. Procedure

  1. The provider identifies that the patient’s BMI is outside of normal parameters.
  2. A follow-up plan is recommended to address the abnormal BMI.
  3. However, the follow-up plan is not completed due to a documented medical reason.

4. When to use HCPCS code G9716

HCPCS code G9716 should be used in cases where the provider has documented that the patient’s BMI is outside of normal parameters and a follow-up plan is recommended. However, the follow-up plan is not completed due to a valid medical reason. It is important to ensure that the medical reason for not completing the follow-up plan is clearly documented in the patient’s medical record.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9716, healthcare providers need to ensure that the patient’s medical record includes the following documentation:

  • Documentation of the patient’s BMI being outside of normal parameters.
  • Documentation of the recommended follow-up plan.
  • Documentation of the valid medical reason for not completing the follow-up plan.

Providers should also follow the billing guidelines set forth by the relevant insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9716 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of the effective date of January 01, 2022, 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

The coverage for HCPCS code G9716 is determined by the carrier judgment, as indicated by the coverage code C. This means that the coverage for this code may vary depending on the specific insurance carrier. Providers should check with the relevant insurance carriers to determine the coverage and reimbursement policies for this code.

8. Examples

Here are five examples of scenarios where HCPCS code G9716 should be billed:

  1. A patient’s BMI is documented as being outside of normal parameters, and a follow-up plan is recommended. However, the patient is unable to complete the follow-up plan due to a medical condition that requires immediate attention.
  2. A patient’s BMI is documented as being outside of normal parameters, and a follow-up plan is recommended. However, the patient is unable to complete the follow-up plan due to a scheduled surgery that takes precedence over the follow-up.
  3. A patient’s BMI is documented as being outside of normal parameters, and a follow-up plan is recommended. However, the patient is unable to complete the follow-up plan due to financial constraints.
  4. A patient’s BMI is documented as being outside of normal parameters, and a follow-up plan is recommended. However, the patient is unable to complete the follow-up plan due to personal reasons.
  5. A patient’s BMI is documented as being outside of normal parameters, and a follow-up plan is recommended. However, the patient is unable to complete the follow-up plan due to a change in insurance coverage.

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