How To Use HCPCS Code G9919

HCPCS code G9919 describes a screening performed that yields a positive result and the provision of recommendations. This code is used to identify a specific medical service or procedure that is performed by healthcare providers. In this article, we will explore the details of HCPCS code G9919, 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 G9919?

HCPCS code G9919 is a unique alphanumeric code that is used to identify a specific medical service or procedure. It is part of the Healthcare Common Procedure Coding System (HCPCS), which is a standardized coding system used by healthcare providers, insurers, and government agencies to accurately describe and bill for medical services and procedures.

2. Official Description

The official description of HCPCS code G9919 is “Screening performed and positive and provision of recommendations.” The short description is “Scrn nd pos nd prov of rec.” This description indicates that the code is used to identify a screening procedure that has been performed and yields a positive result, and the healthcare provider has provided recommendations based on the screening results.

3. Procedure

1. The healthcare provider initiates the screening procedure based on the patient’s medical history, symptoms, or risk factors.
2. The screening procedure is performed according to established protocols and guidelines.
3. If the screening results are positive, the healthcare provider evaluates the results and formulates recommendations based on the findings.
4. The recommendations may include further diagnostic tests, treatment options, lifestyle modifications, or referrals to other healthcare specialists.
5. The healthcare provider communicates the recommendations to the patient and documents the screening results and recommendations in the patient’s medical record.

4. When to use HCPCS code G9919

HCPCS code G9919 is used in the context of a screening procedure that has been performed and yields a positive result. It is important to note that this code should only be used when the screening procedure and positive result are documented in the patient’s medical record. The code should not be used for screenings that do not yield a positive result or for screenings that are not followed by the provision of recommendations.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9919, healthcare providers need to ensure that the screening procedure, positive result, and provision of recommendations are clearly documented in the patient’s medical record. The documentation should include the details of the screening procedure performed, the specific positive result obtained, and the recommendations provided to the patient. This documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9919 was added to the Healthcare Common Procedure Coding System on January 01, 2018. As of the effective date, 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 healthcare providers to stay updated on any changes or revisions to HCPCS codes to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

HCPCS code G9919 is subject to Medicare and insurance coverage policies. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the service may be bundled with other services or may not be covered by Medicare or other insurers. The multiple pricing indicator code is 9, which means that the value for this code is not established. Healthcare providers should verify the coverage and reimbursement policies of Medicare and other insurers before billing for this service.

8. Examples

Here are five examples of when HCPCS code G9919 should be billed:

1. A patient undergoes a screening for colorectal cancer and the results are positive. The healthcare provider provides recommendations for further diagnostic tests and treatment options.
2. A patient undergoes a screening for diabetes and the results indicate elevated blood sugar levels. The healthcare provider provides recommendations for lifestyle modifications and referrals to a diabetes specialist.
3. A patient undergoes a screening for breast cancer and the results show a suspicious lump. The healthcare provider provides recommendations for a diagnostic mammogram and a consultation with a breast surgeon.
4. A patient undergoes a screening for hypertension and the results indicate high blood pressure. The healthcare provider provides recommendations for lifestyle modifications and medication management.
5. A patient undergoes a screening for depression and the results indicate significant depressive symptoms. The healthcare provider provides recommendations for counseling and referrals to a mental health professional.