How To Use HCPCS Code G9956

HCPCS code G9956 describes a specific combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes that are administered to a patient either preoperatively or intraoperatively. This code is used to identify and bill for the provision of this particular therapy.

1. What is HCPCS G9956?

HCPCS code G9956 is a specific code used in medical coding to identify the provision of combination therapy involving at least two prophylactic pharmacologic anti-emetic agents of different classes. This therapy is administered to patients either before a surgical procedure (preoperatively) or during the surgery (intraoperatively). It is important to note that this code specifically refers to the combination therapy of anti-emetic agents and not the individual agents themselves.

2. Official Description

The official description of HCPCS code G9956 is as follows: “Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively.” The short description for this code is “Combo thrpy of >= 2 prophly.”

3. Procedure

1. The healthcare provider assesses the patient’s condition and determines the need for prophylactic pharmacologic anti-emetic therapy.
2. Based on the patient’s medical history, allergies, and other relevant factors, the provider selects at least two anti-emetic agents from different classes.
3. The selected anti-emetic agents are administered to the patient either before the surgical procedure (preoperatively) or during the surgery (intraoperatively).
4. The provider monitors the patient’s response to the combination therapy and adjusts the dosage or medication as necessary.
5. Documentation of the combination therapy, including the names of the administered anti-emetic agents, their dosages, and the timing of administration, should be accurately recorded in the patient’s medical record.

4. When to use HCPCS code G9956

HCPCS code G9956 should be used when a healthcare provider administers a combination therapy of at least two prophylactic pharmacologic anti-emetic agents of different classes to a patient either before a surgical procedure or during the surgery. It is important to ensure that the therapy meets the specific criteria outlined in the code description.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9956, healthcare providers should ensure that the following documentation requirements are met:

• Accurate documentation of the combination therapy, including the names of the administered anti-emetic agents, their dosages, and the timing of administration.
• Supporting medical records that justify the need for the combination therapy and demonstrate medical necessity.
• Proper coding and submission of the HCPCS code G9956 on the claim form.

6. Historical Information and Code Maintenance

HCPCS code G9956 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 medical coders to stay updated on any changes or revisions to the code in the future.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code G9956 may vary depending on the specific policies of Medicare and other insurance providers. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare. It is important for healthcare providers to verify the coverage and reimbursement policies of the respective insurance carriers before submitting claims.

8. Examples

Here are five examples of scenarios where HCPCS code G9956 may be used:

1. A patient undergoing a major surgical procedure receives a combination therapy of two prophylactic pharmacologic anti-emetic agents of different classes preoperatively.
2. During a laparoscopic surgery, the patient is administered a combination therapy of three prophylactic pharmacologic anti-emetic agents of different classes intraoperatively.
3. A patient with a history of severe postoperative nausea and vomiting receives a combination therapy of two prophylactic pharmacologic anti-emetic agents of different classes preoperatively.
4. During a complex abdominal surgery, the patient is administered a combination therapy of four prophylactic pharmacologic anti-emetic agents of different classes intraoperatively.
5. A patient undergoing chemotherapy receives a combination therapy of two prophylactic pharmacologic anti-emetic agents of different classes before each session.