How To Use HCPCS Code G9979

HCPCS code G9979 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, allowing for real-time communication between the healthcare provider and the patient or their family.

1. What is HCPCS G9979?

HCPCS code G9979 is a unique code that identifies a remote in-home visit for the evaluation and management of a new patient. This code is only used in the context of 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, allowing for real-time communication between the healthcare provider and the patient or their family.

2. Official Description

The official description of HCPCS code G9979 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: an expanded problem focused history; an expanded problem focused examination; 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 of low to moderate severity. Typically, 20 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 a remote in-home visit with a new patient using interactive audio and video technology.
2. The provider conducts an expanded problem focused history, gathering information about the patient’s medical background, symptoms, and concerns.
3. An expanded problem focused examination is performed, which may include visual assessments, observations, and discussions with the patient or their family.
4. The provider engages in straightforward medical decision making based on the information gathered during the visit.
5. Counseling and coordination of care with other healthcare professionals or agencies may be provided, as needed.
6. The visit typically lasts for 20 minutes and is conducted in real-time via audio and video intercommunications technology.

4. When to use HCPCS code G9979

HCPCS code G9979 should only be used in the context of a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. It is specifically for remote in-home visits with new patients. The presenting problem(s) during these visits are typically of low to moderate severity. The use of interactive audio and video technology is essential for real-time communication between the provider and the patient or their family.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9979, healthcare providers need to ensure that the visit meets the specific requirements outlined in the official description. Documentation should include details about the expanded problem focused history, examination, and medical decision making. Additionally, any counseling and coordination of care provided should be clearly documented. It is important to follow Medicare guidelines and submit accurate and complete documentation to support the billing of this code.

6. Historical Information and Code Maintenance

HCPCS code G9979 was added to the Healthcare Common Procedure Coding System on October 01, 2018. As of now, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important to stay updated with any future changes or revisions to the code, as well as any updates to the Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model.

7. Medicare and Insurance Coverage

HCPCS code G9979 is payable by Medicare. The pricing indicator code 13 indicates that the price for this code is established by carriers, meaning it is not otherwise classified and is subject to individual determination and carrier discretion. The multiple pricing indicator code A signifies that the code is not applicable as HCPCS priced under one methodology. It is important to check with other insurers regarding their coverage and pricing policies for this specific code.

8. Examples

Here are five examples of scenarios where HCPCS code G9979 may be billed:

1. A healthcare provider conducts a remote in-home visit with a new patient who is experiencing mild respiratory symptoms. The provider performs an expanded problem focused history and examination, engages in straightforward medical decision making, and provides counseling on self-care measures. The visit lasts for 20 minutes and is conducted via audio and video technology.
2. A provider initiates a remote in-home visit with a new patient who recently underwent surgery. The provider assesses the patient’s incision site, discusses post-operative care instructions, and coordinates follow-up appointments with other healthcare professionals involved in the patient’s care. The visit lasts for 20 minutes and is conducted in real-time using audio and video technology.
3. A healthcare provider conducts a remote in-home visit with a new patient who has recently been diagnosed with a chronic condition. The provider gathers information about the patient’s medical history, educates the patient on managing their condition, and coordinates care with other healthcare professionals involved in the patient’s treatment. The visit lasts for 20 minutes and is conducted via audio and video technology.
4. A provider initiates a remote in-home visit with a new patient who is experiencing symptoms of anxiety. The provider conducts an expanded problem focused history, performs a mental health assessment, and provides counseling on coping strategies. The visit lasts for 20 minutes and is conducted in real-time using audio and video technology.
5. A healthcare provider conducts a remote in-home visit with a new patient who requires medication management. The provider reviews the patient’s medication list, addresses any concerns or side effects, and coordinates with the patient’s primary care physician to ensure appropriate medication adjustments. The visit lasts for 20 minutes and is conducted via audio and video technology.