How To Use HCPCS Code G9957

HCPCS code G9957 describes the documentation of a medical reason for not receiving combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively. This code is used to indicate that a patient did not receive the recommended combination therapy due to intolerance or other medical reasons.

1. What is HCPCS G9957?

HCPCS code G9957 is a specific code used in medical coding to identify the documentation of a medical reason for not receiving combination therapy. It is important for medical coders to accurately assign this code to ensure proper reimbursement and documentation of the patient’s medical condition.

2. Official Description

The official description of HCPCS code G9957 is “Documentation of medical reason for not receiving combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason).” The short description for this code is “Doc med rsn no combo thrpy.”

3. Procedure

1. When documenting the medical reason for not receiving combination therapy, the healthcare provider should clearly state the specific reason for not administering the recommended combination therapy.
2. The documentation should include details about the patient’s intolerance or other medical reasons that prevented the administration of the combination therapy.
3. The healthcare provider should ensure that the documentation is clear, concise, and supports the medical necessity for not providing the combination therapy.

4. When to use HCPCS code G9957

HCPCS code G9957 should be used when a patient does not receive the recommended combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively. This code is used to document the medical reason for not administering the combination therapy, such as intolerance or other medical reasons.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9957, healthcare providers need to ensure that the documentation clearly supports the medical reason for not providing the combination therapy. The documentation should include details about the patient’s intolerance or other medical reasons that prevented the administration of the combination therapy. It is important to accurately code and document the medical necessity for not administering the recommended therapy to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9957 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

The coverage for HCPCS code G9957 is determined by the carrier judgment. Medicare and other insurance providers may have specific guidelines and policies regarding the reimbursement for this code. It is important for healthcare providers to review the coverage policies of the respective payers to ensure proper reimbursement.

8. Examples

Here are some examples of when HCPCS code G9957 should be billed:

1. A patient with a known allergy to one of the prophylactic pharmacologic anti-emetic agents recommended for combination therapy.
2. A patient with a medical condition that contraindicates the use of combination therapy.
3. A patient who experienced severe adverse reactions to previous combination therapy.
4. A patient who is unable to tolerate the side effects of the recommended combination therapy.
5. A patient who has a medical reason documented by the healthcare provider for not receiving the recommended combination therapy.