How To Use HCPCS Code G9731

HCPCS code G9731 describes a specific situation where a patient is unable to complete the Lower Extremity Physical Performance (LEPF) Prom at the initial evaluation and/or discharge due to various reasons such as blindness, illiteracy, severe mental incapacity, or language incompatibility. It is important to note that this code should only be used when an adequate proxy is not available to complete the assessment on behalf of the patient.

1. What is HCPCS G9731?

HCPCS code G9731 is a unique alphanumeric code that is used to identify a specific scenario where a patient is unable to complete the LEPF Prom due to certain limitations. This code is important for accurately documenting and billing for the services provided in such cases.

2. Official Description

The official description of HCPCS code G9731 is “Patient unable to complete the LEPF Prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity, or language incompatibility and an adequate proxy is not available.” The short description for this code is “Pt unbl cmplt lepf prom.”

3. Procedure

  1. The healthcare provider should first assess the patient’s ability to complete the LEPF Prom during the initial evaluation or discharge.
  2. If the patient is unable to complete the assessment due to blindness, illiteracy, severe mental incapacity, or language incompatibility, the provider should document this information in the patient’s medical record.
  3. An adequate proxy, who can accurately represent the patient’s physical performance, should be sought. If no such proxy is available, the provider should proceed with the appropriate documentation.
  4. The provider should clearly indicate in the medical record the reasons why the patient was unable to complete the LEPF Prom and the efforts made to find an adequate proxy.

4. When to use HCPCS code G9731

HCPCS code G9731 should be used when a patient is unable to complete the LEPF Prom at the initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity, or language incompatibility, and an adequate proxy is not available. It is important to accurately document the reasons for the inability to complete the assessment and the efforts made to find a suitable proxy.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9731, healthcare providers should ensure that the medical documentation clearly supports the reasons for the patient’s inability to complete the LEPF Prom and the absence of an adequate proxy. This documentation should be detailed and include relevant information such as the patient’s condition, any language barriers, or any other factors that contributed to the inability to complete the assessment.

6. Historical Information and Code Maintenance

HCPCS code G9731 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of January 01, 2021, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. The pricing indicator code for HCPCS code G9731 is 00, which indicates that the service is not separately priced by Part B. This means that the service is either not covered, bundled, or used by Part A only.

7. Medicare and Insurance Coverage

Medicare and other insurance coverage for HCPCS code G9731 may vary. It is important to check with the specific payer to determine if this code is payable and the reimbursement rates. The multiple pricing indicator code for HCPCS code G9731 is 9, which means it is not applicable as HCPCS is not priced separately by Part B or the value is not established. This indicates that the pricing indicator is ’99’.

8. Examples

Here are some examples of scenarios where HCPCS code G9731 should be billed:

  1. A patient with severe mental incapacity is unable to complete the LEPF Prom during the initial evaluation, and no suitable proxy is available.
  2. A patient who is blind cannot complete the LEPF Prom due to the nature of the assessment, and no adequate proxy is present.
  3. An illiterate patient is unable to complete the LEPF Prom, and efforts to find a suitable proxy have been unsuccessful.
  4. A patient with language incompatibility is unable to understand the instructions for the LEPF Prom, and no appropriate proxy is available.
  5. A patient with multiple limitations, such as severe mental incapacity and blindness, is unable to complete the LEPF Prom, and no adequate proxy can accurately represent their physical performance.

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