How To Use HCPCS Code G9748

HCPCS code G9748 describes a specific situation where a patient has been approved by a qualified transplant program and is scheduled to receive a living donor kidney transplant. This code is used to identify and document this particular medical procedure. In this article, we will explore the details and usage of HCPCS code G9748, 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 G9748?

HCPCS code G9748 is a unique alphanumeric code that is part of the Healthcare Common Procedure Coding System (HCPCS). It is used to identify a specific medical procedure or service provided to patients. In the case of G9748, it specifically refers to patients who have been approved by a qualified transplant program and are scheduled to receive a living donor kidney transplant.

2. Official Description

The official description of HCPCS code G9748 is “Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant.” This description accurately reflects the purpose and context of this code.

3. Procedure

  1. The procedure for HCPCS code G9748 involves several steps:
    • Initial evaluation and approval by a qualified transplant program: The patient must undergo a thorough evaluation to determine their eligibility for a living donor kidney transplant. This evaluation includes medical tests, assessments, and consultations with healthcare professionals.
    • Scheduling the transplant procedure: Once the patient has been approved by the transplant program, the transplant surgery is scheduled. This involves coordinating with the living donor, surgical team, and other healthcare providers involved in the procedure.
    • Preparation for the transplant: Prior to the surgery, the patient may need to undergo additional medical tests, consultations, and preparations to ensure they are physically and mentally ready for the transplant.
    • Living donor kidney transplant: The actual transplant surgery takes place, where the living donor’s kidney is transplanted into the recipient’s body. This procedure is performed by a skilled surgical team in a hospital or transplant center.
    • Post-transplant care and monitoring: After the transplant, the patient requires close monitoring, follow-up appointments, and ongoing care to ensure the success of the transplant and to prevent complications.

4. When to use HCPCS code G9748

HCPCS code G9748 should be used when documenting and billing for patients who have been approved by a qualified transplant program and are scheduled to receive a living donor kidney transplant. It is important to ensure that the patient meets the specific eligibility criteria and guidelines set by the transplant program and that the transplant procedure is scheduled and confirmed.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9748, healthcare providers need to ensure proper documentation and billing for the service. This may include:

  • Documentation of the patient’s approval by a qualified transplant program
  • Documentation of the scheduled transplant procedure
  • Documentation of any pre-transplant evaluations, tests, or consultations
  • Documentation of the transplant surgery itself, including details of the living donor and any other relevant information
  • Documentation of post-transplant care and monitoring

Providers should follow the specific billing guidelines and requirements set by their respective payers, such as Medicare or private insurance companies, to ensure accurate and timely reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code G9748 was added to the Healthcare Common Procedure Coding System on January 01, 2017. It has an effective date of January 01, 2021. As of December 31, 2020, this code has been terminated. The termination of this code indicates that it is no longer valid for use in documenting and billing for living donor kidney transplants. Providers should ensure they are using the most up-to-date and appropriate codes for their services.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G9748 may vary depending on the specific policies and guidelines of each payer. It is important for healthcare providers to verify coverage and reimbursement policies with the respective payers to ensure proper billing and reimbursement for the service. The pricing indicator code for G9748 is 00, which indicates that the service is not separately priced by Part B and may be bundled or not covered. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS G9748 is not priced separately by Part B or the value is not established.

8. Examples

Here are some examples of when HCPCS code G9748 should be billed:

  1. Example 1: A patient has been approved by a qualified transplant program and is scheduled to receive a living donor kidney transplant. The transplant surgery is successfully performed, and the patient undergoes post-transplant care and monitoring.
  2. Example 2: A patient has been approved by a qualified transplant program for a living donor kidney transplant. However, due to unforeseen circumstances, the transplant surgery is postponed or canceled.
  3. Example 3: A patient is initially approved by a qualified transplant program for a living donor kidney transplant but later deemed ineligible due to medical or other reasons.
  4. Example 4: A patient is scheduled to receive a living donor kidney transplant but decides to withdraw from the transplant program before the surgery takes place.
  5. Example 5: A patient is approved by a qualified transplant program for a living donor kidney transplant, but the transplant surgery is unsuccessful or results in complications requiring additional medical interventions.

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