How To Use HCPCS Code G9728

HCPCS code G9728 describes a situation where a patient refuses to participate in a specific medical procedure or treatment. This code is used to indicate that the patient has declined to undergo a recommended intervention, despite the healthcare provider’s recommendation. In this article, we will explore the details of HCPCS code G9728, 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 G9728?

HCPCS code G9728 is used to identify cases where a patient refuses to participate in a specific medical procedure or treatment. It signifies that the patient has made an informed decision to decline the recommended intervention, even though it may be beneficial for their health. This code is essential for accurately documenting the patient’s choice and ensuring proper coding and billing.

2. Official Description

The official description of HCPCS code G9728 is “Patient refused to participate.” This concise description clearly indicates that the patient has declined to undergo the recommended procedure or treatment.

3. Procedure

  1. The healthcare provider should thoroughly explain the procedure or treatment to the patient, including its purpose, potential benefits, and any associated risks or side effects.
  2. The patient should be given sufficient time to consider the information provided and ask any questions they may have.
  3. If the patient decides to refuse the procedure, the healthcare provider should document this decision in the patient’s medical record.
  4. The provider should use HCPCS code G9728 to indicate that the patient has declined to participate in the recommended intervention.

4. When to use HCPCS code G9728

HCPCS code G9728 should be used when a patient refuses to participate in a specific medical procedure or treatment. It is crucial to accurately document the patient’s decision to decline the intervention, as it may have implications for their future healthcare management and decision-making.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9728, healthcare providers need to ensure proper documentation in the patient’s medical record. The documentation should clearly state that the patient has refused to participate in the recommended procedure or treatment. This documentation is essential for accurate coding and billing purposes.

6. Historical Information and Code Maintenance

HCPCS code G9728 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 documenting cases where patients refuse to participate in recommended interventions.

7. Medicare and Insurance Coverage

HCPCS code G9728 falls under the coverage code C, which signifies that the determination of coverage is based on carrier judgment. Medicare and other insurance providers may have specific guidelines and policies regarding the coverage of services or treatments when a patient refuses to participate. It is essential to consult the respective payer’s guidelines for accurate billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G9728 should be billed:

  1. A patient is recommended to undergo a surgical procedure but decides to decline due to personal reasons.
  2. A patient is advised to receive a specific medication but refuses to take it due to concerns about potential side effects.
  3. A patient is recommended to undergo a diagnostic test but chooses not to proceed with it due to financial constraints.
  4. A patient is offered a certain therapy but declines it based on their personal beliefs or preferences.
  5. A patient is advised to participate in a clinical trial but decides not to enroll due to concerns about the experimental nature of the treatment.

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