How To Use HCPCS Code G9995

HCPCS code G9995 describes patients who use palliative care services at any time during the measurement period. This code is used to identify and track patients who receive palliative care, which focuses on providing relief from the symptoms and stress of a serious illness. Palliative care aims to improve the quality of life for patients and their families by addressing physical, emotional, and spiritual needs.

1. What is HCPCS G9995?

HCPCS code G9995 is a specific code used in medical coding to indicate patients who utilize palliative care services during the measurement period. It helps healthcare providers and insurance companies track and analyze the utilization of palliative care services among patients.

2. Official Description

The official description of HCPCS code G9995 is “Patients who use palliative care services any time during the measurement period.” The short description for this code is “Pall serv during meas.”

3. Procedure

  1. During the measurement period, healthcare providers should identify patients who receive palliative care services.
  2. Document the details of the palliative care services provided to each patient.
  3. Assign the HCPCS code G9995 to indicate the utilization of palliative care services.

4. When to use HCPCS code G9995

HCPCS code G9995 should be used when a patient receives palliative care services at any time during the measurement period. It is important to accurately document and code the utilization of palliative care services to ensure proper tracking and analysis of patient care.

5. Billing Guidelines and Documentation Requirements

When billing for palliative care services using HCPCS code G9995, healthcare providers should ensure the following:

  • Document the specific palliative care services provided to the patient.
  • Include the date and duration of each palliative care service.
  • Submit the claim with the appropriate HCPCS code G9995.

6. Historical Information and Code Maintenance

HCPCS code G9995 was added to the Healthcare Common Procedure Coding System on January 1, 2022. It has an effective date of January 1, 2024. This code is classified as a discontinued procedure or modifier code, indicating that it will no longer be used after December 31, 2023. There have been no maintenance actions taken for this code, as indicated by the action code D, which means discontinue procedure or modifier code.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover palliative care services, including those identified by HCPCS code G9995. However, the coverage and reimbursement policies may vary. It is important for healthcare providers to review the specific guidelines and requirements of each payer to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G9995 should be billed:

  1. A patient with advanced cancer receives palliative care services to manage pain and improve quality of life.
  2. An elderly patient with a terminal illness receives palliative care services to address physical and emotional symptoms.
  3. A patient with a chronic illness receives palliative care services to manage symptoms and provide support for end-of-life planning.
  4. A patient with a life-limiting illness receives palliative care services to address spiritual and emotional needs.
  5. A patient with a progressive neurological condition receives palliative care services to enhance comfort and provide support for the patient and their family.

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