How To Use HCPCS Code G9869

HCPCS code G9869 describes the receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a Medicare-approved CMMI model, within a time frame of 10-20 minutes. This code falls under the category of CMMI Asyntelehealth and is used to identify and bill for specific telehealth services provided to patients.

1. What is HCPCS G9869?

HCPCS code G9869 is a specific code used in medical coding to identify and bill for the receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation. This code is applicable only in a Medicare-approved CMMI (Center for Medicare and Medicaid Innovation) model and is used to report telehealth services provided to patients.

2. Official Description

The official description of HCPCS code G9869 is “Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a Medicare-approved CMMI model, 10-20 minutes.” The short description for this code is “CMMI Asyntelehealth 10-20min.”

3. Procedure

1. The healthcare provider receives remote, asynchronous images of the patient’s dermatologic and/or ophthalmologic condition.
2. The provider analyzes the images to evaluate the patient’s condition.
3. The analysis may involve reviewing the images for signs of skin conditions, eye diseases, or other relevant findings.
4. The provider documents the analysis and any recommended treatment or further evaluation.

4. When to use HCPCS code G9869

HCPCS code G9869 should be used when a healthcare provider receives and analyzes remote, asynchronous images for dermatologic and/or ophthalmologic evaluation within a time frame of 10-20 minutes. This code is applicable only in a Medicare-approved CMMI model, indicating that the telehealth services provided must meet the specific requirements and guidelines set forth by Medicare and the CMMI model.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9869, healthcare providers need to document the following:

• The receipt of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation.
• The time spent on analyzing the images, which should fall within the 10-20 minute range.
• The findings of the analysis, including any recommended treatment or further evaluation.

Providers should ensure that the documentation supports the medical necessity and appropriateness of the telehealth service provided.

6. Historical Information and Code Maintenance

HCPCS code G9869 was added to the Healthcare Common Procedure Coding System on January 01, 2018. As of April 01, 2021, 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 billing and coding practices.

7. Medicare and Insurance Coverage

Medicare coverage for HCPCS code G9869 is determined by the specific CMMI model in which the service is provided. The pricing indicator code for this code is 13, which indicates that the price is established by carriers, based on carrier discretion and individual determination. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. It is important for healthcare providers to verify coverage and reimbursement policies with Medicare and other insurance carriers.

8. Examples

Here are five examples of when HCPCS code G9869 should be billed:

1. A dermatologist receives remote images of a patient’s skin condition and spends 15 minutes analyzing the images to provide a diagnosis and treatment plan.
2. An ophthalmologist receives asynchronous images of a patient’s eye for evaluation and spends 12 minutes reviewing the images and documenting findings.
3. A healthcare provider participating in a Medicare-approved CMMI model receives remote images of a patient’s dermatologic and ophthalmologic conditions and spends 18 minutes analyzing the images to determine the need for further evaluation or treatment.
4. A telehealth provider receives remote images of a patient’s skin condition and spends 10 minutes analyzing the images to provide a consultation and recommendations for care.
5. An ophthalmologist receives asynchronous images of a patient’s eye for evaluation and spends 20 minutes reviewing the images, documenting findings, and recommending appropriate treatment.