How To Use HCPCS Code G9853

HCPCS code G9853 describes a specific situation where a patient has been admitted to the intensive care unit (ICU) within the last 30 days of their life. This code is used to identify and track these cases for billing and documentation purposes. In this article, we will explore the details of HCPCS code G9853, 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 G9853?

HCPCS code G9853 is a unique code that is used to indicate that a patient has been admitted to the ICU within the last 30 days of their life. This code helps healthcare providers and payers track and identify these specific cases for billing and documentation purposes. It is important to use this code accurately and appropriately to ensure proper reimbursement and accurate medical records.

2. Official Description

The official description of HCPCS code G9853 is “Patient admitted to the ICU in the last 30 days of life.” This description clearly states the specific situation that this code represents, providing clarity for medical coders and billers.

3. Procedure

1. There is no specific procedure associated with HCPCS code G9853. This code is used solely to indicate that a patient has been admitted to the ICU within the last 30 days of their life.

4. When to use HCPCS code G9853

HCPCS code G9853 should be used when a patient has been admitted to the ICU within the last 30 days of their life. This code is specific to this situation and should not be used for any other circumstances. It is important to accurately document and code this information to ensure proper billing and reimbursement.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9853, healthcare providers should ensure that the patient’s medical records clearly indicate the admission to the ICU within the last 30 days of their life. This information should be documented accurately and in detail to support the use of this code. When billing for services related to this ICU stay, it is important to include this code on the claim form to indicate the specific situation being billed.

6. Historical Information and Code Maintenance

HCPCS code G9853 was added to the Healthcare Common Procedure Coding System on January 01, 2017. It is important to note that this code is terminated as of December 31, 2023. This means that it should no longer be used for services provided on or after January 01, 2024. It is crucial for medical coders and billers to stay updated on code changes and terminations to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may have specific coverage policies for services associated with HCPCS code G9853. It is important to consult the respective payer’s guidelines and policies to determine if this code is payable and how the service or supply will be priced. The pricing indicator code for HCPCS code G9853 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 G9853 should be billed:

1. A patient with a terminal illness is admitted to the ICU for palliative care within the last 30 days of their life.
2. An elderly patient with multiple comorbidities is admitted to the ICU for end-of-life care within the last 30 days of their life.
3. A patient with advanced cancer is admitted to the ICU for pain management and comfort measures within the last 30 days of their life.
4. A patient with a severe traumatic injury is admitted to the ICU for end-of-life support within the last 30 days of their life.
5. A patient with a progressive neurodegenerative disease is admitted to the ICU for respiratory support within the last 30 days of their life.