How To Use HCPCS Code G9987

HCPCS code G9987 describes a bundled payment for care improvement advanced (BPCI Advanced) model home visit for patient assessment performed by clinical staff. This code is specifically used for an individual who is not considered homebound and includes various components such as patient assessment of clinical status, safety and fall prevention, functional status and ambulation, medication reconciliation and management, compliance with orders and plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. It is important to note that this code is only applicable for a BPCI Advanced model episode of care and may not be billed for a 30-day period covered by a transitional care management code.

1. What is HCPCS G9987?

HCPCS code G9987 is a specific code used to identify a bundled payment for care improvement advanced (BPCI Advanced) model home visit for patient assessment performed by clinical staff. This code is used for an individual who is not considered homebound and includes various components related to patient assessment and care.

2. Official Description

The official description of HCPCS code G9987 is “Bundled payments for care improvement advanced (BPCI Advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a BPCI Advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code.” The short description for this code is “BPCI Advanced in home visit.”

3. Procedure

1. The provider begins the procedure by conducting a comprehensive patient assessment of the individual’s clinical status.
2. They also assess and implement safety measures to prevent falls and ensure the well-being of the patient.
3. Functional status and ambulation are evaluated to determine the patient’s ability to perform daily activities and mobility.
4. Medication reconciliation and management are performed to ensure proper adherence to prescribed medications and prevent any potential drug interactions.
5. The provider also ensures compliance with orders and the plan of care, making sure that the patient is following the recommended treatment and interventions.
6. Activities of daily living, such as bathing, dressing, and eating, are assessed to determine the patient’s level of independence and need for assistance.
7. Lastly, the provider ensures that the patient is connected to community resources and other services that may be beneficial for their overall well-being.

4. When to use HCPCS code G9987

HCPCS code G9987 should be used in the context of a bundled payment for care improvement advanced (BPCI Advanced) model home visit for patient assessment. It is specifically for individuals who are not considered homebound. This code should only be used for a BPCI Advanced model episode of care and cannot be billed for a 30-day period covered by a transitional care management code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9987, healthcare providers need to ensure that they document the comprehensive patient assessment and all the components included in the code description. This documentation should include details of the patient’s clinical status, safety measures implemented, functional status and ambulation assessment, medication reconciliation and management, compliance with orders and plan of care, performance of activities of daily living, and any connections made to community and other services. Proper documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9987 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.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G9987 is determined by carrier judgment (coverage code C). The pricing indicator code for this code is 13, which means that the price is established by carriers based on individual determination and carrier discretion. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. It is advisable to check with Medicare or other insurance providers regarding the coverage and reimbursement policies for this specific code.

8. Examples

Here are some examples of when HCPCS code G9987 should be billed:

1. A clinical staff member performs a comprehensive home visit for patient assessment, including all the components mentioned in the code description, for an individual who is not considered homebound and is part of a BPCI Advanced model episode of care.
2. During the home visit, the clinical staff assesses the patient’s clinical status, implements safety measures, evaluates functional status and ambulation, reconciles and manages medications, ensures compliance with orders and plan of care, assesses activities of daily living, and connects the patient to community resources.
3. The provider documents all the details of the home visit and submits the claim using HCPCS code G9987 for accurate billing and reimbursement.