How To Use HCPCS Code G9860

HCPCS code G9860 describes a specific situation where a patient has spent less than three days in hospice care. This code is used to indicate that the patient did not receive the full duration of hospice care typically provided. In this article, we will explore the details of HCPCS code G9860, 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 G9860?

HCPCS code G9860 is used to identify patients who have spent less than three days in hospice care. It signifies that the patient did not receive the full duration of hospice care typically provided. This code is important for accurately documenting and billing for the services rendered in such cases.

2. Official Description

The official description of HCPCS code G9860 is “Pt less 3d hospice.” This concise description clearly indicates that the patient has spent less than three days in hospice care.

3. Procedure

1. When using HCPCS code G9860, the healthcare provider should first confirm that the patient has indeed spent less than three days in hospice care.
2. The provider should then document the specific dates and duration of the hospice care received by the patient.
3. It is crucial to accurately record the start and end dates of the hospice care period to ensure proper billing and documentation.
4. Additionally, any relevant details or circumstances surrounding the patient’s shortened hospice stay should be documented for reference and future audits.

4. When to use HCPCS code G9860

HCPCS code G9860 should be used when a patient has spent less than three days in hospice care. This code helps to differentiate such cases from those where the patient has received the full duration of hospice care. It is essential to use this code accurately to reflect the actual length of the patient’s hospice stay.

5. Billing Guidelines and Documentation Requirements

When billing for services associated with HCPCS code G9860, healthcare providers need to ensure proper documentation. The following guidelines should be followed:

• Document the start and end dates of the patient’s hospice care period.
• Include any relevant details or circumstances surrounding the shortened hospice stay.
• Ensure that all documentation is accurate, complete, and supports the use of HCPCS code G9860.

6. Historical Information and Code Maintenance

HCPCS code G9860 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 remains unchanged and continues to serve its purpose in accurately documenting and billing for cases where a patient has spent less than three days in hospice care.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover services associated with HCPCS code G9860. However, it is important to note that the pricing indicator code for this code is 00, which signifies 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. Healthcare providers should verify coverage and reimbursement policies with the respective payers before submitting claims.

8. Examples

Here are five examples of when HCPCS code G9860 should be billed:

1. A patient was admitted to hospice care but passed away within 48 hours, resulting in a hospice stay of less than three days.
2. A patient’s condition improved significantly, and they were discharged from hospice care before completing the full three-day period.
3. A patient was mistakenly admitted to hospice care but was discharged within 24 hours due to a misdiagnosis.
4. A patient opted to discontinue hospice care after only two days and pursued alternative treatment options.
5. A patient’s family decided to transfer them to a different healthcare facility after two days of hospice care, resulting in an incomplete hospice stay.