How To Use HCPCS Code G9969

HCPCS code G9969 describes the scenario where a clinician who referred a patient to another clinician receives a report from the clinician to whom the patient was referred. This code is used to indicate the communication between the referring clinician and the clinician who provided care to the patient. In this article, we will explore the details of HCPCS code G9969, 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 G9969?

HCPCS code G9969 is used to identify the situation where a clinician who referred a patient to another clinician receives a report from the clinician to whom the patient was referred. It signifies the communication between the referring clinician and the clinician who provided care to the patient.

2. Official Description

The official description of HCPCS code G9969 is “Clinician who referred the patient to another clinician received a report from the clinician to whom the patient was referred.” The short description for this code is “Pvdr rfrd pt rprt rcvd.”

3. Procedure

1. The referring clinician initiates the referral process by identifying the need for specialized care or services for the patient.
2. The referring clinician identifies a clinician or healthcare provider who can provide the required care or services.
3. The referring clinician sends a referral to the identified clinician, providing relevant patient information and the reason for the referral.
4. The clinician who received the referral evaluates the patient’s condition and provides the necessary care or services.
5. After providing care to the patient, the clinician who received the referral prepares a report summarizing the care provided and the patient’s progress.
6. The report is sent back to the referring clinician, ensuring effective communication and continuity of care.

4. When to use HCPCS code G9969

HCPCS code G9969 should be used when a clinician who referred a patient to another clinician receives a report from the clinician to whom the patient was referred. It is important to accurately document this communication to ensure proper coordination of care and continuity of treatment.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9969, healthcare providers need to document the referral process, including the referring clinician’s information, the referred clinician’s information, the reason for the referral, and the report received from the referred clinician. This documentation should be maintained in the patient’s medical record to support the use of this code.

6. Historical Information and Code Maintenance

HCPCS code G9969 was added to the Healthcare Common Procedure Coding System on January 01, 2018. As of the effective date of January 01, 2023, 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 G9969 may vary. 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. The multiple pricing indicator code is 9, which signifies that the value for this code is not established or not applicable as HCPCS is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9969 should be billed:

1. A primary care physician refers a patient to a specialist for further evaluation. The specialist provides care to the patient and sends a report back to the primary care physician.
2. A dentist refers a patient to an oral surgeon for a complex dental procedure. The oral surgeon performs the procedure and sends a report detailing the treatment to the referring dentist.
3. A psychiatrist refers a patient to a psychologist for counseling sessions. The psychologist provides the counseling services and sends a report summarizing the sessions to the referring psychiatrist.
4. A primary care physician refers a patient to a physical therapist for rehabilitation after a surgery. The physical therapist provides the necessary therapy and sends a progress report to the referring physician.
5. An ophthalmologist refers a patient to a retinal specialist for further evaluation of a retinal condition. The retinal specialist examines the patient and sends a report back to the referring ophthalmologist.