How To Use HCPCS Code G9975

HCPCS code G9975 describes the documentation of medical reasons for not performing a dilated macular examination. This code is used to indicate that the healthcare provider has a valid medical reason for not conducting a dilated macular examination on a patient.

1. What is HCPCS G9975?

HCPCS code G9975 is a specific code that is used to identify the documentation of medical reasons for not performing a dilated macular examination. It is important for medical coders to accurately assign this code when the healthcare provider has a valid medical reason for not conducting a dilated macular examination on a patient.

2. Official Description

The official description of HCPCS code G9975 is “Documentation of medical reason(s) for not performing a dilated macular examination.” The short description for this code is “Doc med rsn no dil mac exam.”

3. Procedure

1. The healthcare provider should thoroughly document the medical reason(s) for not performing a dilated macular examination.
2. The documentation should clearly explain the specific medical condition or circumstances that prevent the dilated macular examination.
3. It is important for the healthcare provider to provide detailed information to support the medical reason(s) for not performing the examination.

4. When to use HCPCS code G9975

HCPCS code G9975 should be used when the healthcare provider has a valid medical reason for not performing a dilated macular examination. This code is used to indicate that there is a documented medical condition or circumstance that prevents the examination from being conducted.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9975, healthcare providers need to ensure that they have documented the medical reason(s) for not performing a dilated macular examination. The documentation should clearly explain the specific medical condition or circumstances that prevent the examination. This documentation is crucial for accurate coding and billing.

6. Historical Information and Code Maintenance

HCPCS code G9975 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

The coverage of HCPCS code G9975 may vary depending on the insurance provider. It is important for healthcare providers to check with the specific insurance company to determine if this code is payable. Medicare may cover this code based on carrier judgment, as indicated by the coverage code C.

8. Examples

Here are five examples of when HCPCS code G9975 should be billed:

1. A patient has a severe allergy to the dilating drops used in a dilated macular examination, and the healthcare provider documents this allergy as the medical reason for not performing the examination.
2. A patient has a medical condition that makes it unsafe to dilate their pupils, and the healthcare provider documents this condition as the medical reason for not performing the examination.
3. A patient is unable to tolerate the discomfort caused by the dilation process, and the healthcare provider documents this intolerance as the medical reason for not performing the examination.
4. A patient has a history of adverse reactions to dilating drops, and the healthcare provider documents this history as the medical reason for not performing the examination.
5. A patient has a medical condition that contraindicates the use of dilating drops, and the healthcare provider documents this contraindication as the medical reason for not performing the examination.