How To Use HCPCS Code G9978

HCPCS code G9978 describes a remote in-home visit for the evaluation and management of a new patient. This code is specifically used in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. The visit is conducted using interactive audio and video technology in real time, allowing for effective communication between the healthcare provider and the patient.

1. What is HCPCS G9978?

HCPCS code G9978 is a unique code that identifies a remote in-home visit for the evaluation and management of a new patient. This visit is conducted using interactive audio and video technology, allowing for real-time communication between the healthcare provider and the patient. The purpose of this visit is to assess the patient’s medical condition, provide counseling and coordination of care, and make medical decisions based on the information gathered during the visit.

2. Official Description

The official description of HCPCS code G9978 is as follows: “Remote in-home visit for the evaluation and management of a new patient for use only in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are self-limited or minor. Typically, 10 minutes are spent with the patient or family or both via real-time, audio and video intercommunications technology.”

3. Procedure

1. The healthcare provider initiates the remote in-home visit using interactive audio and video technology.
2. The provider gathers information about the patient’s medical history, focusing on the presenting problem(s) and any relevant past medical conditions.
3. A problem-focused examination is conducted, assessing the patient’s physical condition and any visible symptoms.
4. Based on the gathered information, the provider engages in straightforward medical decision making, determining the appropriate course of action for the patient’s care.
5. Counseling and coordination of care with other healthcare professionals or agencies may be provided, depending on the nature of the problem(s) and the needs of the patient or their family.
6. The remote in-home visit typically lasts for 10 minutes and is conducted in real time via audio and video intercommunications technology.

4. When to use HCPCS code G9978

HCPCS code G9978 should be used when conducting a remote in-home visit for the evaluation and management of a new patient. It is important to note that this code is only applicable in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. The visit should meet the specific requirements outlined in the official description, including a problem-focused history, a problem-focused examination, and straightforward medical decision making. Additionally, the presenting problem(s) should be self-limited or minor.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9978, healthcare providers should ensure that they have documented the necessary information to support the visit. This includes the patient’s medical history, the problem-focused examination findings, and the medical decision making process. Additionally, any counseling and coordination of care provided should be clearly documented. It is important to follow the specific billing guidelines set forth by Medicare or other insurers to ensure accurate reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code G9978 was added to the Healthcare Common Procedure Coding System on October 01, 2018. As of the provided information, there have been no maintenance actions taken for this code, indicating that no updates or revisions have been made since its addition.

7. Medicare and Insurance Coverage

HCPCS code G9978 is payable by Medicare. The pricing indicator code 13 indicates that the price for this service is established by carriers, meaning that it is determined by Medicare or other insurers. The multiple pricing indicator code A signifies that the code is not applicable under multiple pricing methodologies. Healthcare providers should refer to Medicare or other insurers’ guidelines for specific information on how this service is priced and reimbursed.

8. Examples

Here are five examples of when HCPCS code G9978 should be billed:

1. A healthcare provider conducts a remote in-home visit for a new patient who is experiencing a minor respiratory infection. The provider gathers the patient’s medical history, performs a problem-focused examination, and engages in straightforward medical decision making to determine the appropriate treatment plan.
2. A healthcare provider conducts a remote in-home visit for a new patient who recently underwent a minor surgical procedure. The provider assesses the patient’s post-operative condition, provides counseling on wound care, and coordinates care with the surgeon to ensure proper follow-up.
3. A healthcare provider conducts a remote in-home visit for a new patient who is seeking management for a self-limited skin rash. The provider evaluates the rash, provides counseling on symptom management, and coordinates care with a dermatologist for further evaluation if necessary.
4. A healthcare provider conducts a remote in-home visit for a new patient who is experiencing minor musculoskeletal pain. The provider assesses the patient’s pain level, provides counseling on self-care techniques, and coordinates care with a physical therapist for additional treatment options.
5. A healthcare provider conducts a remote in-home visit for a new patient who is seeking guidance on managing a minor gastrointestinal issue. The provider gathers the patient’s medical history, provides counseling on dietary modifications, and coordinates care with a gastroenterologist for further evaluation if needed.