How To Use HCPCS Code G9954

HCPCS code G9954 describes a specific scenario where a patient exhibits two or more risk factors for post-operative vomiting. This code is used to identify and document this particular condition, allowing healthcare providers to accurately bill for the services provided.

1. What is HCPCS G9954?

HCPCS code G9954 is a unique alphanumeric code that is part of the Healthcare Common Procedure Coding System (HCPCS). It is used to classify and identify specific medical procedures, services, and supplies. In the case of G9954, it is specifically used to indicate that a patient exhibits two or more risk factors for post-operative vomiting.

2. Official Description

The official description for HCPCS code G9954 is “Patient exhibits 2 or more risk factors for post-operative vomiting.” The short description for this code is “Pt >2 rsk fac post-op vomit.”

3. Procedure

1. During the pre-operative assessment, the healthcare provider identifies the patient’s risk factors for post-operative vomiting.
2. If the patient exhibits two or more risk factors, the provider documents this information in the patient’s medical record.
3. The provider uses HCPCS code G9954 to indicate the presence of these risk factors for post-operative vomiting.

4. When to use HCPCS code G9954

HCPCS code G9954 should be used when a patient exhibits two or more risk factors for post-operative vomiting. These risk factors may include, but are not limited to:

• History of post-operative vomiting
• Female gender
• Non-smoker
• Use of opioids for pain management
• History of motion sickness

It is important for healthcare providers to thoroughly assess and document the patient’s risk factors to ensure accurate coding and billing.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9954, healthcare providers should ensure that the following documentation requirements are met:

• Medical record documentation should clearly indicate the presence of two or more risk factors for post-operative vomiting.
• Documentation should include a detailed description of the risk factors identified and any relevant patient history.
• Providers should also include any additional supporting documentation, such as laboratory results or diagnostic tests, if applicable.

6. Historical Information and Code Maintenance

HCPCS code G9954 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.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover services or supplies associated with HCPCS code G9954. However, it is important to note that 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 or not covered by Medicare or other insurers. Providers should verify coverage and reimbursement policies with the respective payers.

8. Examples

Here are five examples of scenarios where HCPCS code G9954 would be appropriate:

1. A patient with a history of post-operative vomiting, who is a non-smoker and will be receiving opioids for pain management.
2. A female patient with a history of motion sickness, who will be undergoing a surgical procedure.
3. A patient who is a non-smoker and will be receiving opioids for pain management, but does not have a history of post-operative vomiting.
4. A male patient with a history of post-operative vomiting, who will not be receiving opioids for pain management.
5. A patient who is a non-smoker and has no history of post-operative vomiting or motion sickness, but will be undergoing a surgical procedure.