How To Use HCPCS Code G9990

HCPCS code G9990 describes a situation where a patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period. This code is used to indicate that the patient has not been administered any pneumococcal vaccines as per the recommended guidelines.

1. What is HCPCS G9990?

HCPCS code G9990 is a specific code used in medical coding to identify the absence of pneumococcal conjugate or polysaccharide vaccine administration in patients who are 19 years old or older. This code is important for tracking and monitoring vaccination rates and ensuring that patients receive the necessary immunizations to protect against pneumococcal diseases.

2. Official Description

The official description of HCPCS code G9990 is “Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period.” The short description for this code is “No pneum vax admin 19+.”

3. Procedure

1. Review the patient’s medical records to determine if they have received any pneumococcal conjugate or polysaccharide vaccine.
2. If the patient has not received any pneumococcal vaccines on or after their 19th birthday and before the end of the measurement period, assign HCPCS code G9990.
3. Ensure accurate documentation of the patient’s vaccination history and the reason for not receiving the pneumococcal vaccines.

4. When to use HCPCS code G9990

HCPCS code G9990 should be used when a patient who is 19 years old or older has not received any pneumococcal conjugate or polysaccharide vaccine during the specified time frame. This code indicates that the patient is not up to date with the recommended pneumococcal vaccination schedule.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9990, healthcare providers should ensure that the patient’s medical records clearly document the absence of pneumococcal vaccine administration. This documentation should include the patient’s age, the date of their 19th birthday, and the specific measurement period being considered. It is important to accurately record the reasons for not administering the vaccine, such as patient refusal or contraindications.

6. Historical Information and Code Maintenance

HCPCS code G9990 was added to the Healthcare Common Procedure Coding System on January 01, 2022. It has an action effective date of January 01, 2024, indicating a change in the long description of the procedure or modifier code. As of now, there have been no maintenance actions taken for this code.

7. Medicare and Insurance Coverage

HCPCS code G9990 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the administration of pneumococcal vaccines is bundled or not covered as a separate service. The multiple pricing indicator code is 9, which means that the value is not established or applicable for this code.

8. Examples

Here are five examples of when HCPCS code G9990 should be billed:

1. A 25-year-old patient visits their primary care physician for a routine check-up. The physician reviews the patient’s vaccination history and determines that they have not received any pneumococcal vaccines. HCPCS code G9990 should be assigned to indicate the absence of pneumococcal vaccine administration.
2. A 65-year-old patient presents to the hospital for treatment of a respiratory infection. The healthcare provider reviews the patient’s medical records and finds no documentation of pneumococcal vaccine administration. HCPCS code G9990 should be assigned to indicate the absence of pneumococcal vaccine administration.
3. A 40-year-old patient visits an urgent care clinic for a minor injury. The healthcare provider asks about the patient’s vaccination history and discovers that they have not received any pneumococcal vaccines. HCPCS code G9990 should be assigned to indicate the absence of pneumococcal vaccine administration.
4. A 50-year-old patient visits a pharmacy for a flu shot. The pharmacist reviews the patient’s vaccination history and finds no record of pneumococcal vaccine administration. HCPCS code G9990 should be assigned to indicate the absence of pneumococcal vaccine administration.
5. A 70-year-old patient visits a specialist for a chronic condition. The specialist reviews the patient’s medical records and determines that they have not received any pneumococcal vaccines. HCPCS code G9990 should be assigned to indicate the absence of pneumococcal vaccine administration.