How To Use HCPCS Code G9959

HCPCS code G9959 describes the use of systemic antimicrobials that are not prescribed. This code is used to indicate instances where antimicrobial medications are administered without a specific prescription from a healthcare provider. In this article, we will explore the details of HCPCS code G9959, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9959?

HCPCS code G9959 is used to identify the administration of systemic antimicrobials without a prescription. It is important to note that this code specifically refers to antimicrobial medications and not other types of medications. The use of this code indicates that the antimicrobial medication was administered without a specific prescription from a healthcare provider.

2. Official Description

The official description of HCPCS code G9959 is “Systemic antimicrobials not prescribed.” The short description for this code is “Systemic antimicro not presc.”

3. Procedure

1. Before administering the systemic antimicrobial, ensure that it is not prescribed by a healthcare provider.
2. Verify the appropriateness of administering the antimicrobial without a prescription based on the patient’s condition and medical history.
3. Administer the systemic antimicrobial following the appropriate dosage and administration guidelines.
4. Document the administration of the antimicrobial in the patient’s medical record, including the reason for administering it without a prescription.

4. When to use HCPCS code G9959

HCPCS code G9959 should be used in situations where systemic antimicrobials are administered without a prescription. This may occur in emergency situations where immediate treatment is necessary, or in cases where the patient’s condition requires immediate antimicrobial intervention and a prescription cannot be obtained in a timely manner.

5. Billing Guidelines and Documentation Requirements

When billing for the administration of systemic antimicrobials without a prescription using HCPCS code G9959, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the patient’s condition and medical history that justifies the administration of the antimicrobial without a prescription.
• Documentation of the dosage and administration details of the antimicrobial.
• Documentation of any adverse reactions or complications that may arise from the administration of the antimicrobial.

6. Historical Information and Code Maintenance

HCPCS code G9959 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 insurance coverage for HCPCS code G9959 may vary. It is important to consult the specific coverage policies of the respective payers to determine if reimbursement is available for the administration of systemic antimicrobials without a prescription. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value for this code is not established.

8. Examples

Here are five examples of when HCPCS code G9959 should be billed:

1. A patient arrives at the emergency department with a severe infection and requires immediate administration of an antimicrobial medication before a prescription can be obtained.
2. A patient with a known antibiotic allergy develops a serious infection and requires immediate administration of an alternative antimicrobial medication without a prescription.
3. A patient with a compromised immune system develops a fever and shows signs of a possible bacterial infection. The healthcare provider decides to administer an antimicrobial medication without a prescription due to the patient’s high risk for infection.
4. A patient with a history of recurrent urinary tract infections experiences symptoms consistent with an infection and requires immediate administration of an antimicrobial medication without a prescription.
5. A patient undergoing a surgical procedure develops a surgical site infection and requires immediate administration of an antimicrobial medication without a prescription to prevent further complications.