How To Use HCPCS Code G9734

HCPCS code G9734 describes a situation where a patient refuses to participate in a specific medical procedure or intervention. This code is used to indicate that the patient has declined to undergo a recommended treatment or diagnostic test. It is important for medical coders to understand the meaning and usage of this code in order to accurately document and bill for healthcare services.

1. What is HCPCS G9734?

HCPCS code G9734 is specifically used to identify cases where a patient has refused to participate in a recommended medical procedure or intervention. This code serves as a documentation tool to indicate that the patient has declined the proposed treatment or test. It is important to note that this code does not provide any further details about the specific procedure or intervention that was refused. It simply signifies the patient’s decision to decline participation.

2. Official Description

The official description of HCPCS code G9734 is “Patient refused to participate.” The short description for this code is “Refused to participate.” These descriptions accurately reflect the purpose and meaning of this code, indicating that the patient has chosen not to undergo the recommended procedure or intervention.

3. Procedure

  1. The procedure for HCPCS code G9734 involves documenting the patient’s refusal to participate in the recommended medical procedure or intervention.
  2. The healthcare provider should clearly communicate the risks, benefits, and alternatives of the proposed treatment to the patient.
  3. The patient’s decision to refuse participation should be documented in the medical record, including the date and time of the refusal.
  4. It is important to ensure that the patient’s decision is voluntary and well-informed.
  5. The documentation should also include any discussions or conversations with the patient regarding their reasons for refusing the procedure.

4. When to use HCPCS code G9734

HCPCS code G9734 should be used when a patient refuses to participate in a recommended medical procedure or intervention. This code is applicable in situations where the patient has been fully informed about the procedure and has made a voluntary decision to decline participation. It is important to accurately document the patient’s refusal to ensure proper coding and billing for healthcare services.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9734, healthcare providers need to document the patient’s refusal to participate in the recommended procedure or intervention. The documentation should include the following:

  • Date and time of the patient’s refusal
  • Clear indication that the patient was fully informed about the procedure
  • Reasons provided by the patient for refusing the procedure, if available

Proper documentation is crucial for accurate coding and billing. It helps to establish the medical necessity of the procedure and ensures that the patient’s decision is respected and appropriately recorded.

6. Historical Information and Code Maintenance

HCPCS code G9734 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 patient refusals to participate in medical procedures or interventions.

7. Medicare and Insurance Coverage

HCPCS code G9734 is covered by Medicare and other insurance providers. 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 either not covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which means that it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9734 should be billed:

  1. A patient refuses to undergo a recommended surgical procedure due to personal reasons.
  2. A patient declines to participate in a diagnostic test that has been recommended by their healthcare provider.
  3. A patient chooses not to receive a specific medication or treatment option that has been suggested by their physician.
  4. A patient declines to participate in a clinical trial or research study.
  5. A patient refuses to undergo a recommended screening procedure, such as a mammogram or colonoscopy.

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