How To Use HCPCS Code G9805

HCPCS code G9805 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 and have a life expectancy of six months or less. Hospice services focus on providing comfort and support to patients and their families, rather than attempting to cure the underlying illness.

1. What is HCPCS G9805?

HCPCS code G9805 is a specific code used in medical coding to identify patients who utilize hospice services during the measurement period. It is important to note that this code does not provide any specific details about the type or duration of hospice services received by the patient. Instead, it serves as a marker to indicate that the patient has accessed hospice care at some point during the designated time frame.

2. Official Description

The official description of HCPCS code G9805 is “Patients who use hospice services any time during the measurement period.” The short description for this code is “Pt w/hosp anytime msmt per.” These descriptions accurately summarize the purpose and usage of the code.

3. Procedure

  1. Identify patients who have utilized hospice services during the measurement period.
  2. Ensure accurate documentation of the patient’s hospice care in the medical records.
  3. Assign HCPCS code G9805 to indicate the patient’s utilization of hospice services.

4. When to use HCPCS code G9805

HCPCS code G9805 should be used when a patient has received hospice services at any time during the measurement period. The measurement period may vary depending on the specific reporting requirements or guidelines set forth by the healthcare facility, insurance provider, or regulatory agency.

5. Billing Guidelines and Documentation Requirements

When billing for services associated with HCPCS code G9805, healthcare providers should ensure that the medical documentation clearly supports the patient’s utilization of hospice services. This may include documentation of the patient’s terminal illness, prognosis, and the specific hospice services provided. It is important to follow the billing guidelines and requirements set forth by the relevant insurance providers or payers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9805 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of the provided information, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders to stay updated on any changes or revisions to HCPCS codes to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

The coverage and reimbursement for HCPCS code G9805 may vary depending on the specific insurance provider or payer. It is important to consult the relevant Medicare guidelines or private insurance policies to determine the coverage and payment policies for hospice services. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code G9805 should be billed:

  1. A patient with a terminal illness receives hospice services for pain management and emotional support during the measurement period.
  2. An elderly individual with a life expectancy of less than six months enters a hospice program and receives end-of-life care.
  3. A patient with advanced cancer transitions from curative treatment to hospice care for palliative care and symptom management.
  4. An individual with a progressive neurological disease receives hospice services to address their physical, emotional, and spiritual needs.
  5. A patient with end-stage heart failure is enrolled in a hospice program and receives specialized care to improve their quality of life.

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