How To Use HCPCS Code G9958

HCPCS code G9958 describes a specific situation where a patient did not receive 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 the patient did not receive the recommended combination therapy for preventing nausea and vomiting during or after a surgical procedure.

1. What is HCPCS G9958?

HCPCS code G9958 is a specific code used in medical coding to identify cases where a patient did not receive 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 the patient did not receive the recommended combination therapy for preventing nausea and vomiting during or after a surgical procedure.

2. Official Description

The official description of HCPCS code G9958 is “Patient did not receive 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 “No combo prohpyl thrp for pt.”

3. Procedure

1. The healthcare provider should assess the patient’s risk for postoperative nausea and vomiting (PONV) based on various factors such as age, gender, medical history, and type of surgery.
2. If the patient is at high risk for PONV, the provider should prescribe a combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes.
3. The patient should receive the prescribed combination therapy either preoperatively or intraoperatively, depending on the specific recommendations.
4. If the patient did not receive the recommended combination therapy, HCPCS code G9958 should be used to indicate this situation in the medical coding.

4. When to use HCPCS code G9958

HCPCS code G9958 should be used when a patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively. This code is specifically used to indicate that the patient did not receive the recommended combination therapy for preventing nausea and vomiting during or after a surgical procedure.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9958, healthcare providers need to document the specific reasons why the patient did not receive the recommended combination therapy. This documentation should include any contraindications or patient preferences that influenced the decision to not administer the combination therapy. It is important to provide clear and detailed documentation to support the use of this code for accurate billing.

6. Historical Information and Code Maintenance

HCPCS code G9958 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. This code is still currently active and can be used for appropriate cases.

7. Medicare and Insurance Coverage

The coverage for HCPCS code G9958 may vary depending on the insurance provider. Medicare considers this code as a carrier judgment, meaning that the coverage determination is made by the insurance carrier based on their policies and guidelines. It is important to check with the specific insurance provider to determine the coverage and reimbursement for this code.

8. Examples

Here are five examples of when HCPCS code G9958 should be billed:

1. A patient undergoes a surgical procedure and is at high risk for postoperative nausea and vomiting. However, the healthcare provider decides not to administer the recommended combination therapy due to a contraindication.
2. A patient undergoes a surgical procedure and is at high risk for postoperative nausea and vomiting. The healthcare provider prescribes the combination therapy, but the patient refuses to receive it.
3. A patient undergoes a surgical procedure and is at high risk for postoperative nausea and vomiting. The healthcare provider forgets to administer the recommended combination therapy during the procedure.
4. A patient undergoes a surgical procedure and is at high risk for postoperative nausea and vomiting. The healthcare provider administers a single prophylactic pharmacologic anti-emetic agent instead of the recommended combination therapy.
5. A patient undergoes a surgical procedure and is at high risk for postoperative nausea and vomiting. The healthcare provider is not aware of the recommended combination therapy and does not administer any prophylactic pharmacologic anti-emetic agents.