How To Use HCPCS Code G9735

HCPCS code G9735 describes a specific situation where a patient is unable to complete the shoulder functional status (FS) prom at the initial evaluation and/or discharge due to various reasons such as blindness, illiteracy, severe mental incapacity, or language incompatibility. In such cases, an adequate proxy is not available to assist the patient. This code falls under the category of medical care and is not separately priced by Part B of Medicare.

1. What is HCPCS G9735?

HCPCS code G9735 is used to identify patients who are unable to complete the shoulder functional status (FS) prom at the initial evaluation and/or discharge. This code is specifically used when the patient faces challenges such as blindness, illiteracy, severe mental incapacity, or language incompatibility, and there is no suitable proxy available to assist them. It is important to note that this code does not cover situations where an adequate proxy is available.

2. Official Description

The official description of HCPCS code G9735 is “Patient unable to complete the shoulder fs 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 shld fs prom.”

3. Procedure

  1. The healthcare provider should assess the patient’s ability to complete the shoulder functional status (FS) prom at the initial evaluation and/or discharge.
  2. If the patient is unable to complete the FS prom due to blindness, illiteracy, severe mental incapacity, or language incompatibility, the provider should document this information.
  3. The provider should also confirm that there is no adequate proxy available to assist the patient in completing the FS prom.
  4. Ensure that the documentation clearly supports the patient’s inability to complete the FS prom and the absence of an adequate proxy.

4. When to use HCPCS code G9735

HCPCS code G9735 should be used when a patient is unable to complete the shoulder functional status (FS) prom at the initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity, or language incompatibility. It is important to note that this code should only be used when there is no suitable proxy available to assist the patient.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9735, healthcare providers need to ensure that the documentation clearly supports the patient’s inability to complete the shoulder FS prom and the absence of an adequate proxy. The documentation should include details about the patient’s condition or circumstances that prevent them from completing the FS prom independently. It is crucial to provide accurate and comprehensive documentation to support the medical necessity of using this code.

6. Historical Information and Code Maintenance

HCPCS code G9735 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of January 01, 2020, 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 G9735 is 00, indicating that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value is not established for this code.

7. Medicare and Insurance Coverage

HCPCS code G9735 is covered by Medicare. However, it is important to note that this code is not separately priced by Part B. The service or supply represented by this code is bundled or not covered by Part B. Therefore, it is essential to review the specific guidelines and policies of Medicare and other insurance providers to determine the coverage and reimbursement for this code.

8. Examples

Here are five examples of when HCPCS code G9735 should be billed:

  1. A patient with severe mental incapacity is unable to complete the shoulder FS prom at the initial evaluation and no adequate proxy is available.
  2. A patient who is blind cannot complete the shoulder FS prom due to their visual impairment, and there is no suitable proxy to assist them.
  3. An illiterate patient is unable to complete the shoulder FS prom at the initial evaluation, and there is no adequate proxy available to help them.
  4. A patient who does not speak the language used for the FS prom is unable to complete it, and there is no suitable proxy to assist them.
  5. A patient with multiple challenges, such as severe mental incapacity and illiteracy, is unable to complete the shoulder FS prom, and there is no adequate proxy available to assist them.

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