How To Use HCPCS Code G9755

HCPCS code G9755 describes the documentation of medical reasons for not including a recommended interval and modality for follow-up or for no follow-up, as well as the source of recommendations. This code is used in specific situations where patients may have unexplained fever or are immunocompromised and at risk for infection. It falls under the category of medical care and is not separately priced by Part B.

1. What is HCPCS G9755?

HCPCS code G9755 is used to document the medical reasons for not including a recommended interval and modality for follow-up or for no follow-up. It is important for healthcare providers to accurately document the reasons why a recommended follow-up interval or modality is not included in the patient’s care plan. This code helps in providing a clear understanding of the medical decision-making process and the rationale behind the absence of follow-up recommendations.

2. Official Description

The official description of HCPCS code G9755 is “Documentation of medical reason(s) for not including a recommended interval and modality for follow-up or for no follow-up, and source of recommendations (e.g., patients with unexplained fever, immunocompromised patients who are at risk for infection).” The short description for this code is “Doc med rsn no fllw up.”

3. Procedure

  1. When using HCPCS code G9755, healthcare providers should thoroughly document the medical reasons for not including a recommended interval and modality for follow-up or for no follow-up.
  2. Providers should clearly state the specific medical reasons, such as patients with unexplained fever or immunocompromised patients who are at risk for infection.
  3. The documentation should also include the source of recommendations, which could be based on clinical guidelines, expert opinions, or other relevant sources.
  4. It is important to provide detailed and specific information to support the medical decision-making process and justify the absence of follow-up recommendations.

4. When to use HCPCS code G9755

HCPCS code G9755 should be used in situations where there are valid medical reasons for not including a recommended interval and modality for follow-up or for no follow-up. Some examples of when this code may be used include:

  • Patients with unexplained fever
  • Immunocompromised patients who are at risk for infection

It is important to carefully assess each patient’s condition and determine if there are legitimate medical reasons for not including follow-up recommendations. The documentation should clearly explain the rationale behind the decision.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9755, healthcare providers need to ensure that the documentation supports the medical reasons for not including a recommended interval and modality for follow-up or for no follow-up. The documentation should clearly state the specific medical reasons and provide the source of recommendations.

It is important to accurately code and document the medical necessity of the service to ensure proper reimbursement. The documentation should be detailed, specific, and support the medical decision-making process.

6. Historical Information and Code Maintenance

HCPCS code G9755 was added to the Healthcare Common Procedure Coding System on January 01, 2017. 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 code’s action effective date is January 01, 2019.

7. Medicare and Insurance Coverage

HCPCS code G9755 is covered by Medicare. The pricing indicator code for this code is 00, which means it is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are some examples of when HCPCS code G9755 should be billed:

  1. A patient with an unexplained fever is seen by a healthcare provider. The provider determines that there is no need for a recommended interval and modality for follow-up due to the nature of the fever. The medical reasons for not including follow-up recommendations are documented using HCPCS code G9755.
  2. An immunocompromised patient who is at risk for infection receives medical care. The healthcare provider decides not to include a recommended interval and modality for follow-up due to the patient’s condition. The medical reasons for not including follow-up recommendations are documented using HCPCS code G9755.

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