How To Use HCPCS Code G9946

HCPCS code G9946 describes a specific scenario where back pain was not measured by the visual analog scale (VAS) or numeric pain scale at one year (9 to 15 months) postoperatively. This code is used to indicate that the patient’s level of back pain was not assessed using these pain measurement tools.

1. What is HCPCS G9946?

HCPCS code G9946 is a specific code used in medical coding to identify cases where back pain was not measured by the visual analog scale (VAS) or numeric pain scale at one year (9 to 15 months) postoperatively. It is important to note that this code only applies to situations where the pain measurement tools were not utilized.

2. Official Description

The official description of HCPCS code G9946 is “Back pain was not measured by the visual analog scale (VAS) or numeric pain scale at one year (9 to 15 months) postoperatively.” The short description for this code is “Bk pain no VAS.”

3. Procedure

1. During the patient’s follow-up visit one year (9 to 15 months) after a surgical procedure, the healthcare provider should assess the patient’s level of back pain.
2. If the provider determines that the visual analog scale (VAS) or numeric pain scale was not used to measure the back pain, HCPCS code G9946 should be assigned.
3. The provider should document the reason why the pain measurement tools were not utilized, such as patient refusal, technical difficulties, or any other relevant factors.

4. When to use HCPCS code G9946

HCPCS code G9946 should be used in cases where the patient’s back pain was not measured using the visual analog scale (VAS) or numeric pain scale at one year (9 to 15 months) postoperatively. It is important to ensure that the pain measurement tools were not used before assigning this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9946, healthcare providers need to document the reason why the visual analog scale (VAS) or numeric pain scale was not used to measure the patient’s back pain. This documentation should include details such as patient refusal, technical difficulties, or any other relevant factors that influenced the decision not to utilize the pain measurement tools.

6. Historical Information and Code Maintenance

HCPCS code G9946 was added to the Healthcare Common Procedure Coding System on January 01, 2018. As of January 01, 2023, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage for HCPCS code G9946 is determined by the carrier’s judgment (coverage code C). It is important to check with Medicare or other insurance providers to determine if this code is payable and to understand the specific pricing and reimbursement policies.

8. Examples

Here are five examples of scenarios where HCPCS code G9946 may be used:

1. A patient undergoes back surgery and during the follow-up visit one year later, the visual analog scale (VAS) or numeric pain scale is not used to measure their back pain.
2. A patient refuses to have their back pain measured using the visual analog scale (VAS) or numeric pain scale during the follow-up visit one year after a surgical procedure.
3. Technical difficulties prevent the healthcare provider from using the visual analog scale (VAS) or numeric pain scale to measure the patient’s back pain during the follow-up visit one year postoperatively.
4. The healthcare facility does not have access to the visual analog scale (VAS) or numeric pain scale, and therefore, the patient’s back pain cannot be measured using these tools during the follow-up visit one year after the surgical procedure.
5. Due to the patient’s specific medical condition or circumstances, the visual analog scale (VAS) or numeric pain scale is not appropriate or feasible for measuring their back pain during the follow-up visit one year postoperatively.