How To Use HCPCS Code G9960

HCPCS code G9960 describes the documentation of medical reason(s) for prescribing systemic antimicrobials. This code is used to indicate that the healthcare provider has documented the medical reasons for prescribing systemic antimicrobial medications to a patient. In this article, we will explore the details of HCPCS code G9960, 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 G9960?

HCPCS code G9960 is used to identify the documentation of medical reason(s) for prescribing systemic antimicrobials. It is important for healthcare providers to accurately document the medical reasons for prescribing these medications to ensure proper patient care and reimbursement.

2. Official Description

The official description of HCPCS code G9960 is “Documentation of medical reason(s) for prescribing systemic antimicrobials.” The short description is “Med rsn sys antimi nt rx.”

3. Procedure

1. When prescribing systemic antimicrobials, the healthcare provider should thoroughly document the medical reasons for prescribing these medications.
2. This documentation should include specific details about the patient’s condition or infection that necessitates the use of systemic antimicrobials.
3. The documentation should also include any relevant laboratory results, diagnostic tests, or clinical findings that support the need for these medications.
4. It is important for the healthcare provider to clearly communicate the medical reasons for prescribing systemic antimicrobials in the patient’s medical record.

4. When to use HCPCS code G9960

HCPCS code G9960 should be used when the healthcare provider has documented the medical reason(s) for prescribing systemic antimicrobials. This code is applicable in various medical contexts where systemic antimicrobial medications are prescribed, such as the treatment of bacterial infections, sepsis, or other conditions where antimicrobial therapy is necessary.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9960, healthcare providers should ensure that the medical reason(s) for prescribing systemic antimicrobials are clearly documented in the patient’s medical record. The documentation should include specific details about the patient’s condition, laboratory results, diagnostic tests, or clinical findings that support the need for these medications.

6. Historical Information and Code Maintenance

HCPCS code G9960 was added to the Healthcare Common Procedure Coding System on January 01, 2018. As of now, 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 healthcare providers to stay updated on any changes or revisions related to this code.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G9960 may vary depending on the carrier’s judgment. It is important for healthcare providers to check with Medicare or other insurance providers to determine the coverage and reimbursement policies for this code. The pricing indicator code for HCPCS code G9960 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 is not established or the code is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9960 should be billed:

1. A patient presents with a severe bacterial infection, and the healthcare provider prescribes systemic antimicrobial medications. The medical record clearly documents the infection and the need for antimicrobial therapy.
2. A patient with sepsis requires systemic antimicrobial medications. The healthcare provider documents the diagnosis of sepsis and the medical reasons for prescribing the antimicrobial therapy.
3. A patient undergoes surgery, and the healthcare provider prescribes systemic antimicrobial prophylaxis to prevent surgical site infections. The medical record includes the surgical procedure details and the rationale for prescribing the antimicrobial prophylaxis.
4. A patient with a confirmed diagnosis of pneumonia receives systemic antimicrobial treatment. The healthcare provider documents the pneumonia diagnosis and the medical reasons for prescribing the antimicrobial therapy.
5. A patient with a urinary tract infection is prescribed systemic antimicrobial medications. The healthcare provider documents the urinary tract infection diagnosis and the medical reasons for prescribing the antimicrobial therapy.