How To Use HCPCS Code G9994

HCPCS code G9994 describes the use of palliative care services by a patient at any time during the measurement period. Palliative care is a specialized form of medical care that focuses on providing relief from the symptoms and stress of a serious illness. It is aimed at improving the quality of life for both the patient and their family.

1. What is HCPCS G9994?

HCPCS code G9994 is used to identify patients who are utilizing palliative care services during the measurement period. Palliative care services can include a range of interventions such as pain management, emotional support, and assistance with decision-making. This code is specific to palliative care and should not be used for other types of medical services.

2. Official Description

The official description of HCPCS code G9994 is “Patient is using palliative care services any time during the measurement period.” The short description for this code is “Pall serv during meas.”

3. Procedure

1. The provider assesses the patient’s medical condition and determines their eligibility for palliative care services.
2. A care plan is developed based on the patient’s individual needs and goals.
3. Palliative care services are provided to the patient, which may include pain management, symptom control, emotional support, and assistance with decision-making.
4. The provider regularly evaluates the patient’s progress and adjusts the care plan as needed.

4. When to use HCPCS code G9994

HCPCS code G9994 should be used when a patient is receiving palliative care services at any time during the measurement period. This code is applicable regardless of the specific medical condition or diagnosis of the patient. It is important to accurately document the use of palliative care services in the medical record to support the use of this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9994, healthcare providers should ensure that the medical record includes documentation of the palliative care services provided to the patient. This may include details such as the specific interventions performed, the frequency and duration of the services, and any changes made to the care plan. It is also important to include the start and end dates of the measurement period in the billing documentation.

6. Historical Information and Code Maintenance

HCPCS code G9994 was added to the Healthcare Common Procedure Coding System on January 01, 2022. As of the effective date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code is relatively new and does not have a historical context or significant changes since its addition.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G9994 may vary depending on the payer. Medicare considers this code to be a carrier judgment, meaning that coverage is determined by the individual Medicare Administrative Contractor (MAC) based on their local coverage policies. Other insurance providers may also have specific guidelines for the coverage of palliative care services. It is important to verify coverage with the payer before providing and billing for these services.

8. Examples

Here are five examples of when HCPCS code G9994 should be billed:

1. A patient with advanced cancer receives palliative care services to manage pain and improve their quality of life.
2. An elderly patient with a chronic illness receives palliative care services to address their physical, emotional, and spiritual needs.
3. A terminally ill patient receives palliative care services to provide comfort and support during their end-of-life journey.
4. A patient with a progressive neurological disorder receives palliative care services to manage symptoms such as pain, muscle stiffness, and difficulty swallowing.
5. A patient with a life-limiting illness receives palliative care services to help them make informed decisions about their treatment options and goals of care.