How To Use HCPCS Code G9961

HCPCS code G9961 describes the use of systemic antimicrobials prescribed by healthcare providers. This code is used to identify the administration of antimicrobial medications that are taken orally or through injection to treat systemic infections caused by bacteria, viruses, fungi, or parasites. It is important for medical coders to understand the specific details and guidelines associated with this code in order to accurately document and bill for these services.

1. What is HCPCS G9961?

HCPCS code G9961 is a specific code used to identify the administration of systemic antimicrobials prescribed by healthcare providers. This code is used to indicate the use of medications that are intended to treat systemic infections throughout the body. It is important to note that this code specifically refers to the prescription and administration of antimicrobial medications, rather than the medications themselves.

2. Official Description

The official description for HCPCS code G9961 is “Systemic antimicrobials prescribed.” This description accurately reflects the purpose of this code, which is to identify the prescription and administration of antimicrobial medications used to treat systemic infections.

3. Procedure

1. Before administering systemic antimicrobials, the healthcare provider must first evaluate the patient’s medical history, symptoms, and laboratory test results to determine the appropriate medication and dosage.
2. The healthcare provider will then prescribe the systemic antimicrobial medication, specifying the dosage, frequency, and duration of treatment.
3. The patient may receive the prescription for the systemic antimicrobial medication at a pharmacy or directly from the healthcare provider’s office.
4. If the medication is administered orally, the patient will be instructed on how to take the medication, including any specific instructions regarding food or drink consumption.
5. If the medication is administered through injection, the healthcare provider will follow proper sterile techniques to prepare and administer the medication.
6. The healthcare provider will document the administration of the systemic antimicrobial medication in the patient’s medical record, including the date, time, dosage, and route of administration.

4. When to use HCPCS code G9961

HCPCS code G9961 should be used when a healthcare provider prescribes and administers systemic antimicrobial medications to treat systemic infections. This code is specifically used for antimicrobial medications that are taken orally or through injection, rather than topical or localized treatments. It is important to ensure that the prescribed medication falls within the scope of this code and that the documentation supports the use of systemic antimicrobials.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9961, healthcare providers must ensure that the documentation supports the medical necessity and appropriateness of the systemic antimicrobial medication. This includes documenting the patient’s diagnosis, the specific antimicrobial medication prescribed, the dosage, frequency, and duration of treatment, and any relevant clinical information. It is also important to follow the billing guidelines set forth by the payer, including any specific modifiers or additional documentation requirements.

6. Historical Information and Code Maintenance

HCPCS code G9961 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 used to identify systemic antimicrobials prescribed and has not undergone any significant changes since its addition.

7. Medicare and Insurance Coverage

The coverage for HCPCS code G9961 is determined by the payer’s judgment. 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 or other insurers. It is important to verify the coverage and reimbursement policies of the specific payer before submitting a claim for this code.

8. Examples

Here are five examples of when HCPCS code G9961 should be billed:

1. A patient with a confirmed diagnosis of a systemic bacterial infection is prescribed a course of oral antibiotics by their healthcare provider.
2. A patient with a viral infection requiring systemic treatment is administered antiviral medication through injection by a healthcare provider.
3. A patient with a fungal infection that has spread throughout their body is prescribed systemic antifungal medication by their healthcare provider.
4. A patient with a parasitic infection is prescribed a course of oral antiparasitic medication by their healthcare provider.
5. A patient with a severe systemic infection is admitted to the hospital and receives intravenous antimicrobial therapy as prescribed by their healthcare provider.