How To Use HCPCS Code G9984

HCPCS code G9984 describes a remote in-home visit for the evaluation and management of an established patient. This code is specifically used in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. The visit must meet certain criteria, including the use of interactive audio and video technology, and the provision of counseling and coordination of care with other healthcare professionals or agencies. In this article, we will explore the details of HCPCS code G9984, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9984?

HCPCS code G9984 is a specific code used to identify a remote in-home visit for the evaluation and management of an established patient. This visit is part of the Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. The visit must meet certain criteria, including the use of interactive audio and video technology, counseling and coordination of care with other healthcare professionals or agencies, and the presentation of low to moderate severity problems. The visit typically lasts for 15 minutes and is conducted in real-time through audio and video intercommunications technology.

2. Official Description

The official description of HCPCS code G9984 is as follows: “Remote in-home visit for the evaluation and management of an established patient for use only in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, 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, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology.”

3. Procedure

1. The provider initiates a remote in-home visit with an established patient.
2. The provider uses interactive audio and video technology to communicate with the patient in real-time.
3. The provider conducts an expanded problem focused history, which involves gathering information about the patient’s medical background, symptoms, and any relevant factors.
4. The provider performs an expanded problem focused examination, which may include assessing the patient’s physical condition, vital signs, and any specific areas of concern.
5. The provider engages in medical decision making of low complexity, considering the patient’s symptoms, medical history, and any diagnostic tests or procedures.
6. The provider provides counseling and coordination of care with other physicians, qualified healthcare professionals, or agencies as needed.
7. The provider spends approximately 15 minutes with the patient or family, addressing their concerns and providing necessary guidance and support.

4. When to use HCPCS code G9984

HCPCS code G9984 should 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 established patients. The visit must meet the criteria outlined in the official description, including the use of interactive audio and video technology, counseling and coordination of care, and the presentation of low to moderate severity problems. It is important to ensure that the visit meets these requirements before using HCPCS code G9984.

5. Billing Guidelines and Documentation Requirements

When billing for a remote in-home visit using HCPCS code G9984, healthcare providers need to document the following:

• The use of interactive audio and video technology for the visit.
• The expanded problem focused history, examination, and medical decision making performed during the visit.
• The counseling and coordination of care provided to the patient or family.
• The duration of the visit, which should be approximately 15 minutes.

Providers should also ensure that the visit meets the criteria outlined in the official description and is part of a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care.

6. Historical Information and Code Maintenance

HCPCS code G9984 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.

7. Medicare and Insurance Coverage

HCPCS code G9984 is payable by Medicare. The pricing indicator code 13 indicates that the price for this code is established by carriers, meaning it is determined by Medicare or other insurers. The multiple pricing indicator code A signifies that the code is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code G9984 should be billed:

1. A patient with an established medical condition requires a remote in-home visit for evaluation and management. The provider conducts an expanded problem focused history, examination, and medical decision making of low complexity using interactive audio and video technology. Counseling and coordination of care are provided as needed.
2. An established patient presents with new symptoms that require evaluation and management. The provider conducts an expanded problem focused history, examination, and medical decision making of low complexity through remote in-home visit using interactive audio and video technology. Counseling and coordination of care are provided to address the patient’s concerns.
3. A patient with a chronic condition needs a follow-up visit to monitor their progress. The provider conducts an expanded problem focused history, examination, and medical decision making of low complexity via remote in-home visit using interactive audio and video technology. Counseling and coordination of care are provided to ensure the patient’s ongoing care needs are met.
4. An established patient requires a medication adjustment and ongoing management. The provider conducts an expanded problem focused history, examination, and medical decision making of low complexity during a remote in-home visit using interactive audio and video technology. Counseling and coordination of care are provided to ensure the patient understands the medication changes and can follow the prescribed treatment plan.
5. A patient with multiple chronic conditions needs a comprehensive evaluation and management. The provider conducts an expanded problem focused history, examination, and medical decision making of low complexity through a remote in-home visit using interactive audio and video technology. Counseling and coordination of care are provided to address the patient’s complex healthcare needs.