How To Use HCPCS Code G9726

HCPCS code G9726 describes a situation where a patient refuses to participate in a particular medical procedure or treatment. This code is used to indicate that the patient has declined to undergo a recommended course of action, despite the healthcare provider’s recommendation. It is important for medical coders to understand the specific details and usage guidelines for this code in order to accurately document and bill for services.

1. What is HCPCS G9726?

HCPCS code G9726 is used to identify cases where a patient refuses to participate in a recommended medical procedure or treatment. The code signifies that the patient has made a conscious decision to decline the proposed course of action, even though it may be in their best interest. It is important to note that this code should only be used when the patient’s refusal is documented and confirmed by the healthcare provider.

2. Official Description

The official description for HCPCS code G9726 is “Patient refused to participate.” The short description for this code is “Refused to participate.” These descriptions accurately capture the essence of the code, indicating that the patient has declined to undergo a recommended procedure or treatment.

3. Procedure

1. The healthcare provider should thoroughly explain the proposed procedure or treatment to the patient, including its benefits, risks, and potential outcomes.
2. The patient should be given ample opportunity to ask questions and seek clarification regarding the procedure.
3. If the patient decides to refuse the procedure, the healthcare provider should document this refusal in the patient’s medical record.
4. The documentation should include the reasons provided by the patient for their refusal, as well as any discussions or counseling that took place.
5. It is important for the healthcare provider to respect the patient’s autonomy and decision-making process while ensuring that the risks and consequences of refusing the procedure are clearly communicated.

4. When to use HCPCS code G9726

HCPCS code G9726 should be used when a patient refuses to participate in a recommended medical procedure or treatment. This code is applicable in situations where the patient has been fully informed about the procedure and has consciously decided to decline it. It is important to note that this code should not be used for cases where the patient is unable to provide consent due to their medical condition or incapacity.

5. Billing Guidelines and Documentation Requirements

When billing for services associated with HCPCS code G9726, healthcare providers should ensure that the patient’s refusal is clearly documented in the medical record. The documentation should include the reasons for the patient’s refusal, any discussions or counseling that took place, and the provider’s efforts to inform the patient about the risks and benefits of the recommended procedure. This documentation is crucial for accurate billing and reimbursement purposes.

6. Historical Information and Code Maintenance

HCPCS code G9726 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 remains relevant for cases where a patient refuses to participate in a recommended procedure or treatment.

7. Medicare and Insurance Coverage

HCPCS code G9726 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 may be bundled or not covered by Medicare. Healthcare providers should consult the Medicare Fee Schedule and other relevant guidelines to determine the appropriate billing and reimbursement for services associated with this code.

8. Examples

Here are five examples of when HCPCS code G9726 should be billed:

1. A patient is recommended to undergo a surgical procedure, but they refuse to proceed due to personal reasons.
2. A patient is advised to undergo a series of chemotherapy treatments, but they decline the treatment due to concerns about potential side effects.
3. A patient is recommended to receive a specific medication, but they choose not to take it after considering alternative treatment options.
4. A patient is advised to undergo a diagnostic test, but they refuse to proceed due to fear or anxiety about the procedure.
5. A patient is recommended to participate in a clinical trial, but they decline to enroll due to concerns about the experimental nature of the treatment.