How To Use HCPCS Code G9970

HCPCS code G9970 describes the situation where a clinician who referred a patient to another clinician did not receive a report from the clinician to whom the patient was referred. This code is used to indicate that the referring clinician did not receive any communication or feedback regarding the patient’s condition or treatment from the clinician to whom the patient was referred.

1. What is HCPCS G9970?

HCPCS code G9970 is a specific code used in medical coding to identify the scenario where a referring clinician did not receive a report from the clinician to whom the patient was referred. It is important to accurately assign this code to ensure proper documentation and billing for the services provided.

2. Official Description

The official description of HCPCS code G9970 is “Clinician who referred the patient to another clinician did not receive a report from the clinician to whom the patient was referred.” The short description for this code is “Pvdr rfrd pt no rprt rcvd.”

3. Procedure

1. The referring clinician initiates the referral process by identifying the need for the patient to see another clinician.
2. The referring clinician provides the necessary information and documentation to the clinician to whom the patient is being referred.
3. The referred clinician evaluates the patient and provides the required treatment or services.
4. After the patient’s visit, the referred clinician is responsible for sending a report back to the referring clinician, detailing the patient’s condition, treatment provided, and any recommendations.
5. If the referring clinician does not receive a report from the referred clinician within a reasonable timeframe, HCPCS code G9970 should be assigned to indicate the lack of communication.

4. When to use HCPCS code G9970

HCPCS code G9970 should be used when the referring clinician did not receive a report from the clinician to whom the patient was referred. This code is applicable in situations where there is a lack of communication between the referring and referred clinicians, resulting in the referring clinician being unaware of the patient’s condition or treatment.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9970, healthcare providers need to ensure proper documentation to support the use of this code. The documentation should include evidence that the referring clinician did not receive a report from the referred clinician, such as communication records or documented attempts to obtain the report. It is important to accurately document the lack of communication to justify the use of this code for billing purposes.

6. Historical Information and Code Maintenance

HCPCS code G9970 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. This code remains unchanged since its addition to the system.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code G9970 may vary depending on the payer, such as Medicare or other insurance providers. 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 check with the specific payer’s guidelines and policies to determine the coverage and reimbursement for this code.

8. Examples

Here are five examples of scenarios where HCPCS code G9970 should be billed:

1. A primary care physician refers a patient to a specialist for further evaluation. However, the specialist does not provide any feedback or report to the primary care physician regarding the patient’s condition or treatment.
2. A dentist refers a patient to an oral surgeon for a complex dental procedure. Despite multiple attempts to obtain a report, the dentist does not receive any communication or feedback from the oral surgeon.
3. A psychiatrist refers a patient to a psychologist for therapy sessions. The psychiatrist does not receive any report or updates from the psychologist regarding the patient’s progress or treatment plan.
4. A physical therapist refers a patient to an orthopedic surgeon for a consultation. However, the physical therapist does not receive any report or recommendations from the orthopedic surgeon after the consultation.
5. A primary care physician refers a patient to a radiologist for a specialized imaging study. Despite follow-up inquiries, the primary care physician does not receive any report or findings from the radiologist.