How To Use HCPCS Code G9965

HCPCS code G9965 describes a situation where a patient did not receive at least one well-child visit with a primary care physician (PCP) during the performance period. This code is used to indicate that the patient did not undergo a routine check-up or preventive care visit with their PCP.

1. What is HCPCS G9965?

HCPCS code G9965 is a specific code used in medical coding to identify cases where a patient did not receive a well-child visit with a PCP. It is important for healthcare providers to accurately document and report this code when applicable.

2. Official Description

The official description of HCPCS code G9965 is “Patient did not receive at least one well-child visit with a PCP during the performance period.” The short description for this code is “No well-child visit received by patient.”

3. Procedure

1. When using HCPCS code G9965, the healthcare provider should review the patient’s medical records and determine if they have received a well-child visit with a PCP during the specified performance period.
2. If the patient has not received a well-child visit, the provider should accurately document this information in the patient’s medical record.
3. When submitting claims for reimbursement, the provider should include HCPCS code G9965 to indicate that the patient did not receive a well-child visit.

4. When to use HCPCS code G9965

HCPCS code G9965 should be used when a patient has not received a well-child visit with a PCP during the specified performance period. This code is applicable for cases where the patient did not undergo a routine check-up or preventive care visit with their PCP.

5. Billing Guidelines and Documentation Requirements

When billing for services associated with HCPCS code G9965, healthcare providers should ensure that the patient’s medical record clearly indicates that no well-child visit was received. This documentation should include the date range of the performance period and any relevant details regarding the patient’s healthcare visits during that time.

6. Historical Information and Code Maintenance

HCPCS code G9965 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 G9965 may vary depending on the specific insurance provider. It is important for healthcare providers to verify coverage with the patient’s insurance company before submitting claims. Medicare coverage for this code is subject to carrier judgment, as indicated by the coverage code C.

8. Examples

Here are five examples of when HCPCS code G9965 should be billed:

1. A 2-year-old patient did not receive a well-child visit with their PCP during the performance period.
2. A 5-year-old patient missed their scheduled well-child visit with their PCP.
3. A 10-year-old patient did not have any documented well-child visits with their PCP during the specified performance period.
4. A 15-year-old patient’s parents declined to schedule a well-child visit with their PCP.
5. A 17-year-old patient did not receive a well-child visit due to a scheduling conflict.