How To Use HCPCS Code G9989

HCPCS code G9989 describes the documentation of medical reasons for not administering the pneumococcal vaccine. This code is used when a patient has experienced an adverse reaction to the vaccine or when there are other valid medical reasons for not administering it.

1. What is HCPCS G9989?

HCPCS code G9989 is a specific code used in medical coding to identify the documentation of medical reasons for not administering the pneumococcal vaccine. It is important for healthcare providers to accurately document the reasons for not administering the vaccine to ensure proper coding and billing.

2. Official Description

The official description of HCPCS code G9989 is “Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine).” The short description for this code is “Med rsn no pneum vax.”

3. Procedure

1. When using HCPCS code G9989, the healthcare provider should thoroughly document the medical reasons for not administering the pneumococcal vaccine.
2. This documentation should include specific details about the adverse reaction or other medical reasons that justify not administering the vaccine.
3. The provider should ensure that the documentation is clear, concise, and supports the decision to withhold the vaccine.

4. When to use HCPCS code G9989

HCPCS code G9989 should be used when there are valid medical reasons for not administering the pneumococcal vaccine. This may include cases where the patient has previously experienced an adverse reaction to the vaccine or has a medical condition that contraindicates its use.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies related to HCPCS code G9989, healthcare providers should ensure that the documentation clearly supports the medical reasons for not administering the pneumococcal vaccine. This documentation should be included in the patient’s medical record and should be readily available for review if requested by payers or auditors.

6. Historical Information and Code Maintenance

HCPCS code G9989 was added to the Healthcare Common Procedure Coding System on January 1, 2022. It is important to note that this code is terminated as of December 31, 2022. Therefore, it should not be used for services provided after this date.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may have specific coverage guidelines for HCPCS code G9989. It is important for healthcare providers to familiarize themselves with these guidelines to ensure proper reimbursement. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value is not established or the code is not priced separately by Part B.

8. Examples

Here are some examples of when HCPCS code G9989 should be billed:

1. A patient experienced a severe allergic reaction to a previous dose of the pneumococcal vaccine, and the healthcare provider documented this adverse reaction as the reason for not administering the vaccine.
2. A patient has a medical condition that contraindicates the use of the pneumococcal vaccine, such as a compromised immune system, and the healthcare provider documented this medical reason for not administering the vaccine.
3. A patient has a history of Guillain-Barré syndrome, which is a known adverse reaction to the pneumococcal vaccine, and the healthcare provider documented this medical reason for not administering the vaccine.
4. A patient has a documented allergy to one of the components of the pneumococcal vaccine, and the healthcare provider documented this allergy as the reason for not administering the vaccine.
5. A patient has already received the recommended number of doses of the pneumococcal vaccine based on their age and medical history, and the healthcare provider documented this as the reason for not administering additional doses.