How To Use HCPCS Code G9974

HCPCS code G9974 describes a dilated macular exam performed by a healthcare provider. This code is used to document the presence or absence of macular thickening, geographic atrophy, hemorrhage, and the level of macular degeneration severity. It is important for medical coders to understand the meaning and usage of this code to accurately bill for the services provided.

1. What is HCPCS G9974?

HCPCS code G9974 is a specific code used to identify a dilated macular exam performed by a healthcare provider. This code is used to document the presence or absence of macular thickening, geographic atrophy, hemorrhage, and the level of macular degeneration severity. It is important to note that this code is specific to the examination of the macula, which is the central part of the retina responsible for detailed vision.

2. Official Description

The official description of HCPCS code G9974 is “Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity.” The short description for this code is “Mac exam perf.”

3. Procedure

1. The healthcare provider will begin by dilating the patient’s pupils using eye drops. This allows for a better view of the macula during the examination.
2. Using a specialized ophthalmoscope, the provider will carefully examine the macula for any signs of macular thickening, geographic atrophy, or hemorrhage.
3. The provider will also assess the severity of macular degeneration, if present, and document it accordingly.
4. Throughout the examination, the provider will make detailed notes and observations regarding the macular findings.
5. Once the examination is complete, the provider will document the results and any relevant findings in the patient’s medical record.

4. When to use HCPCS code G9974

HCPCS code G9974 should be used when a healthcare provider performs a dilated macular exam and documents the presence or absence of macular thickening, geographic atrophy, hemorrhage, and the level of macular degeneration severity. This code is specific to the examination of the macula and should not be used for other types of eye exams or procedures.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9974, healthcare providers need to ensure that the following documentation requirements are met:

• The medical record should clearly indicate that a dilated macular exam was performed.
• The presence or absence of macular thickening, geographic atrophy, hemorrhage, and the level of macular degeneration severity should be documented.
• Any additional relevant findings or observations should be included in the medical record.

6. Historical Information and Code Maintenance

HCPCS code G9974 was added to the Healthcare Common Procedure Coding System on January 01, 2018. As of January 01, 2019, 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 other insurance providers may cover the dilated macular exam described by HCPCS code G9974. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This could indicate that the service is bundled with other services or that it is not covered under certain circumstances. It is important for healthcare providers to check with Medicare and other insurance carriers to determine coverage and reimbursement policies for this specific code.

8. Examples

Here are five examples of when HCPCS code G9974 should be billed:

1. A patient with a history of macular degeneration comes in for a routine dilated macular exam. The provider documents the absence of macular thickening, geographic atrophy, and hemorrhage, and notes the severity of macular degeneration.
2. A patient presents with symptoms of macular thickening and blurry vision. The provider performs a dilated macular exam and documents the presence of macular thickening, but no geographic atrophy or hemorrhage.
3. A patient with a known macular hemorrhage undergoes a dilated macular exam to assess the severity and monitor any changes. The provider documents the presence of macular hemorrhage and notes the severity.
4. A patient with a history of geographic atrophy in the macula comes in for a follow-up dilated macular exam. The provider documents the presence of geographic atrophy and notes any changes or progression.
5. A patient with no known macular issues undergoes a routine dilated macular exam. The provider documents the absence of macular thickening, geographic atrophy, and hemorrhage, and notes no signs of macular degeneration.