How To Use HCPCS Code G9986

HCPCS code G9986 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 in real time, and the provision of at least two of the following three key components: a comprehensive history, a comprehensive examination, and medical decision making of high complexity. The visit typically lasts for 40 minutes and involves counseling and coordination of care with other healthcare professionals or agencies, as needed.

1. What is HCPCS G9986?

HCPCS code G9986 is a specific code used to identify a remote in-home visit for the evaluation and management of an established patient. This code is only applicable in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. It is used to indicate that the visit was conducted using interactive audio and video technology in real time, and that it met the criteria of at least two of the following three key components: a comprehensive history, a comprehensive examination, and medical decision making of high complexity. The visit typically lasts for 40 minutes and involves counseling and coordination of care with other healthcare professionals or agencies, as needed.

2. Official Description

The official description of HCPCS code G9986 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: a comprehensive history; a comprehensive examination; medical decision making of high 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 moderate to high severity. Typically, 40 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 visit is conducted in real time using interactive audio and video technology.
3. The provider performs a comprehensive history, which includes gathering information about the patient’s medical background, current symptoms, and any relevant factors.
4. A comprehensive examination is conducted, which may involve assessing the patient’s physical condition, reviewing test results, and evaluating any specific concerns.
5. The provider engages in medical decision making of high complexity, which involves analyzing the patient’s medical information, considering treatment options, and determining the appropriate course of action.
6. Counseling and coordination of care with other physicians, qualified healthcare professionals, or agencies are provided as necessary, based on the nature of the patient’s problem(s) and their needs.
7. The visit typically lasts for 40 minutes, during which time the provider interacts with the patient and/or their family via real-time audio and video communication.

4. When to use HCPCS code G9986

HCPCS code G9986 should be used when a healthcare provider conducts a remote in-home visit for the evaluation and management of an established patient. This code is specifically applicable in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. The visit must meet the criteria of at least two of the following three key components: a comprehensive history, a comprehensive examination, and medical decision making of high complexity. The presenting problem(s) are typically of moderate to high severity, and the visit must be conducted in real time using interactive audio and video technology.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9986, healthcare providers need to document the details of the remote in-home visit, including the comprehensive history, examination, and medical decision making performed. They should also document the counseling and coordination of care provided, as well as the nature of the problem(s) and the needs of the patient or their family. It is important to ensure that the visit meets the criteria outlined in the official description of the code. Providers should follow the billing guidelines set forth by Medicare and provide any necessary supporting documentation to justify the use of this code.

6. Historical Information and Code Maintenance

HCPCS code G9986 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 for healthcare providers to stay updated on any changes or revisions to this code, as well as any historical information that may impact its use.

7. Medicare and Insurance Coverage

HCPCS code G9986 is payable by Medicare and is specifically used in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. The pricing indicator code 13 indicates that the price for this code is established by carriers, and the multiple pricing indicator code A indicates that it is not applicable as HCPCS priced under one methodology. Healthcare providers should consult with Medicare or other insurers to determine the coverage and reimbursement policies for this code.

8. Examples

Here are five examples of when HCPCS code G9986 should be billed:

1. A healthcare provider conducts a remote in-home visit with an established patient who has a history of chronic heart disease. The provider performs a comprehensive history, a comprehensive examination, and medical decision making of high complexity. They also provide counseling and coordination of care with a cardiologist to ensure appropriate management of the patient’s condition.
2. A healthcare provider conducts a remote in-home visit with an established patient who is undergoing cancer treatment. The provider performs a comprehensive history, a comprehensive examination, and medical decision making of high complexity. They also provide counseling and coordination of care with an oncologist to discuss treatment options and address any concerns or side effects.
3. A healthcare provider conducts a remote in-home visit with an established patient who has recently been discharged from the hospital after a stroke. The provider performs a comprehensive history, a comprehensive examination, and medical decision making of high complexity. They also provide counseling and coordination of care with a physical therapist to develop a rehabilitation plan and ensure a smooth transition from hospital to home.
4. A healthcare provider conducts a remote in-home visit with an established patient who has a history of diabetes. The provider performs a comprehensive history, a comprehensive examination, and medical decision making of high complexity. They also provide counseling and coordination of care with a registered dietitian to discuss dietary management and provide education on blood sugar monitoring and insulin administration.
5. A healthcare provider conducts a remote in-home visit with an established patient who is experiencing symptoms of depression. The provider performs a comprehensive history, a comprehensive examination, and medical decision making of high complexity. They also provide counseling and coordination of care with a psychiatrist to assess the need for medication management and discuss therapy options.