How To Use HCPCS Code G9904

HCPCS code G9904 describes the documentation of medical reasons for not screening for tobacco use. This code is used when a healthcare provider determines that it is not appropriate or necessary to screen a patient for tobacco use due to specific medical reasons. It is important for medical coders to understand the meaning and usage of this code in order to accurately report and bill for healthcare services.

1. What is HCPCS G9904?

HCPCS code G9904 is used to indicate that a healthcare provider has documented medical reasons for not screening a patient for tobacco use. These medical reasons may include limited life expectancy or other medical conditions that make tobacco screening unnecessary or inappropriate. It is important for healthcare providers to clearly document these reasons in the patient’s medical record to support the use of this code.

2. Official Description

The official description of HCPCS code G9904 is “Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)”. The short description for this code is “Doc med rsn no tbco scrn”. These descriptions accurately reflect the purpose and usage of this code.

3. Procedure

1. When a healthcare provider determines that it is not necessary or appropriate to screen a patient for tobacco use, they should clearly document the medical reasons for this decision in the patient’s medical record.
2. The documentation should include specific details about the patient’s limited life expectancy or other medical conditions that justify the decision not to screen for tobacco use.
3. It is important for healthcare providers to use clear and concise language when documenting these medical reasons to ensure accurate coding and billing.

4. When to use HCPCS code G9904

HCPCS code G9904 should be used when a healthcare provider has documented medical reasons for not screening a patient for tobacco use. These medical reasons may include limited life expectancy or other medical conditions that make tobacco screening unnecessary or inappropriate. It is important for medical coders to review the patient’s medical record and identify the presence of these documented medical reasons before assigning this code.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9904, healthcare providers should ensure that the patient’s medical record clearly documents the medical reasons for not screening for tobacco use. This documentation should include specific details about the patient’s limited life expectancy or other medical conditions that justify the decision not to screen. By providing thorough and accurate documentation, healthcare providers can support the use of this code and ensure proper reimbursement for their services.

6. Historical Information and Code Maintenance

HCPCS code G9904 was added to the Healthcare Common Procedure Coding System on January 01, 2018. It has a termination date of December 31, 2022. This code is classified as a carrier judgment code, meaning that its coverage is determined by the judgment of the insurance carrier. As of January 01, 2023, there will be no maintenance for this code, indicating that it will no longer be in use.

7. Medicare and Insurance Coverage

Medicare and other insurance carriers may provide coverage for services billed with HCPCS code G9904. However, it is important for healthcare providers to review the specific coverage guidelines of each insurance carrier to determine if this code is payable. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value for this code is not established. Healthcare providers should consult with the appropriate insurance carriers to determine the reimbursement rates for services billed with this code.

8. Examples

Here are five examples of when HCPCS code G9904 may be used:

1. A patient with a terminal illness and a limited life expectancy is not screened for tobacco use.
2. A patient with a severe medical condition that requires immediate attention is not screened for tobacco use.
3. A patient with a documented allergy to tobacco products is not screened for tobacco use.
4. A patient with a history of adverse reactions to tobacco cessation medications is not screened for tobacco use.
5. A patient with a cognitive impairment that prevents them from participating in a tobacco screening is not screened for tobacco use.