How To Use HCPCS Code G9967

HCPCS code G9967 describes the situation where children have not been screened for risk of developmental, behavioral, and social delays using a standardized tool with interpretation and report. This code is used to indicate that the screening process has not been performed for a child, and it is important for medical coders to understand how to properly use this code in their billing and coding practices.

1. What is HCPCS G9967?

HCPCS code G9967 is a specific code used in medical coding to identify the situation where children have not been screened for risk of developmental, behavioral, and social delays using a standardized tool with interpretation and report. This code is important for accurately documenting and billing for the lack of screening in a child’s healthcare record.

2. Official Description

The official description of HCPCS code G9967 is “Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report.” The short description for this code is “No scrn, inter, reprt child.”

3. Procedure

1. The provider should first assess the child’s medical history and determine if a screening for developmental, behavioral, and social delays is necessary.
2. If screening is deemed necessary, the provider should select a standardized tool for the screening process.
3. The provider should administer the screening tool to the child and interpret the results.
4. A report should be generated documenting the screening process, including the tool used, the results, and any recommendations or follow-up actions.
5. If the child has not undergone the screening process, the provider should document this in the medical record and use HCPCS code G9967 for accurate billing and coding purposes.

4. When to use HCPCS code G9967

HCPCS code G9967 should be used when a child has not been screened for risk of developmental, behavioral, and social delays using a standardized tool with interpretation and report. This code is applicable when the screening process has not been performed, and it is important for medical coders to accurately document and bill for this lack of screening in the child’s healthcare record.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9967, healthcare providers need to document the reason why the child was not screened for risk of developmental, behavioral, and social delays using a standardized tool with interpretation and report. This documentation should be detailed and include any relevant information that supports the decision not to perform the screening. When billing for the service, the code G9967 should be included on the claim form to indicate the lack of screening.

6. Historical Information and Code Maintenance

HCPCS code G9967 was added to the Healthcare Common Procedure Coding System on January 01, 2018. It has a termination date of December 31, 2020. This code does not have any maintenance actions associated with it, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders to stay updated on any changes or revisions to the code, as well as its termination date.

7. Medicare and Insurance Coverage

HCPCS code G9967 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the service is bundled or not covered by Part B. The multiple pricing indicator code is 9, which means that the value for this code is not established. It is important for medical coders to understand how this code is priced by Medicare and other insurers to ensure accurate billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G9967 should be billed:

1. A pediatrician did not perform a developmental screening for a 2-year-old child during a routine check-up.
2. A child psychologist did not use a standardized tool to screen for behavioral delays in a 6-year-old child during a counseling session.
3. A primary care physician did not document a report for a social development screening that was not performed on a 4-year-old child.
4. A pediatric nurse practitioner did not interpret the results of a developmental screening for a 3-year-old child.
5. A child psychiatrist did not screen a 10-year-old child for risk of developmental, behavioral, and social delays using a standardized tool with interpretation and report.