How To Use HCPCS Code G9858

HCPCS code G9858 describes a patient who is enrolled in hospice care. This code is used to indicate that the patient is receiving end-of-life care and is no longer seeking curative treatment. It is important for medical coders to understand the meaning and usage of this code in order to accurately document and bill for hospice services.

1. What is HCPCS G9858?

HCPCS code G9858 is used to identify a patient who is enrolled in hospice care. This code indicates that the patient has made the decision to focus on comfort and quality of life rather than seeking curative treatment. Hospice care provides support and medical services for individuals who are in the final stages of a terminal illness.

2. Official Description

The official description of HCPCS code G9858 is “Patient enrolled in hospice.” The short description for this code is “Pt enroll hospice.”

3. Procedure

1. When a patient is determined to be eligible for hospice care, the healthcare provider will enroll the patient in a hospice program.
2. The provider will assess the patient’s medical condition and develop a plan of care that focuses on managing symptoms and providing comfort.
3. The hospice team, which may include doctors, nurses, social workers, and other healthcare professionals, will regularly visit the patient to provide medical care and support.
4. The patient’s condition will be monitored closely, and any necessary adjustments to the plan of care will be made.
5. As the patient’s condition progresses, the hospice team will provide emotional and spiritual support to both the patient and their loved ones.
6. When the patient passes away, the hospice team will provide bereavement support to the family.

4. When to use HCPCS code G9858

HCPCS code G9858 should be used when documenting and billing for a patient who is enrolled in hospice care. This code is applicable when the patient has made the decision to focus on comfort and quality of life rather than seeking curative treatment. It is important to ensure that the patient meets the eligibility criteria for hospice care before using this code.

5. Billing Guidelines and Documentation Requirements

When billing for services related to HCPCS code G9858, healthcare providers should ensure that the documentation accurately reflects the patient’s enrollment in hospice care. This may include documentation of the patient’s decision to forgo curative treatment, the development of a plan of care, and the provision of medical services and support by the hospice team. It is important to follow the specific billing guidelines set forth by Medicare or other insurance providers to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9858 was added to the Healthcare Common Procedure Coding System on January 01, 2017. Since its addition, 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 is still currently in use and has not been terminated or revised.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover services related to HCPCS code G9858. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This may indicate that the services provided under this code are bundled or not covered separately. The multiple pricing indicator code is 9, which means that the value for this code is not established. It is important to check with Medicare or other insurance providers to determine the specific coverage and reimbursement policies for hospice services.

8. Examples

Here are five examples of when HCPCS code G9858 should be billed:

1. A patient with advanced cancer who has decided to discontinue curative treatment and receive hospice care.
2. An elderly patient with end-stage heart failure who has chosen to focus on comfort and quality of life.
3. A patient with a terminal illness who has exhausted all available treatment options and has opted for hospice care.
4. A patient with a progressive neurological disease who has decided to transition to hospice care for symptom management.
5. A patient with end-stage renal disease who has chosen to stop dialysis and receive hospice services.