How To Use HCPCS Code G9761

HCPCS code G9761 describes patients who use hospice services at any time during the measurement period. This code is used to identify and track patients who receive hospice care, which is a specialized form of care for individuals who are terminally ill. In this article, we will explore the details of HCPCS code G9761, 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 G9761?

HCPCS code G9761 is used to identify patients who utilize hospice services during the measurement period. It is important to note that this code specifically pertains to patients who receive hospice care, which is a type of care provided to individuals who have a terminal illness and a life expectancy of six months or less. Hospice care focuses on providing comfort and support to patients and their families, with an emphasis on pain management and symptom control.

2. Official Description

The official description of HCPCS code G9761 is “Patients who use hospice services any time during the measurement period.” The short description is “Pt w/hosp anytime msmt per.” This description accurately reflects the purpose of this code, which is to identify patients who receive hospice care during the designated measurement period.

3. Procedure

1. Patients who meet the criteria for hospice care are enrolled in a hospice program.
2. The hospice team, which may include physicians, nurses, social workers, and other healthcare professionals, provides comprehensive care to the patient.
3. The care provided may include pain management, symptom control, emotional support, spiritual guidance, and assistance with activities of daily living.
4. The hospice team works closely with the patient’s primary care physician to ensure coordinated and appropriate care.
5. Documentation of the patient’s hospice enrollment and the services provided is essential for accurate billing and reimbursement.

4. When to use HCPCS code G9761

HCPCS code G9761 should be used when a patient has utilized hospice services at any time during the designated measurement period. It is important to accurately document the patient’s hospice enrollment and the dates of service to ensure proper coding and billing.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9761, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the patient’s hospice enrollment and the dates of service
• Documentation of the services provided during the hospice care
• Supporting medical records that demonstrate the medical necessity of hospice care

Providers should also follow the billing guidelines set forth by the Centers for Medicare and Medicaid Services (CMS) and any applicable insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9761 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of the effective date, 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 active and available for use in identifying patients who utilize hospice services during the measurement period.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover hospice services for eligible patients. However, the coverage and reimbursement for HCPCS code G9761 may vary depending on the specific insurance plan and the patient’s eligibility criteria. It is important for healthcare providers to verify coverage and follow the guidelines set forth by the respective insurance carriers when billing for hospice services.

8. Examples

Here are five examples of when HCPCS code G9761 should be billed:

1. A patient with a terminal illness enrolls in a hospice program and receives pain management and symptom control services during the measurement period.
2. An eligible patient receives emotional support and counseling from the hospice team throughout the designated measurement period.
3. A patient’s primary care physician refers them to a hospice program, and the patient receives comprehensive care, including nursing visits and assistance with activities of daily living, during the measurement period.
4. A patient’s family receives bereavement support and counseling from the hospice team following the patient’s passing during the measurement period.
5. A patient’s hospice care includes spiritual guidance and support from a chaplain or other religious counselor throughout the designated measurement period.