How To Use HCPCS Code G9997

HCPCS code G9997 describes the documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter. This code is used to indicate that the healthcare provider has recorded the patient’s pregnancy status during the specified time frame. In this article, we will explore the details of HCPCS code G9997, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9997?

HCPCS code G9997 is used to document patient pregnancy during the measurement period prior to and including the current encounter. It serves as a way for healthcare providers to indicate that they have recorded the patient’s pregnancy status. This code is important for tracking and monitoring the healthcare needs of pregnant patients.

2. Official Description

The official description of HCPCS code G9997 is “Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter.” The short description for this code is “Doc pt preg dur msrmt pd.”

3. Procedure

1. During the patient encounter, the healthcare provider should inquire about the patient’s pregnancy status.
2. If the patient is pregnant, the provider should document this information in the patient’s medical record.
3. The documentation should include the date of the encounter and the patient’s pregnancy status.
4. It is important for the provider to accurately record the pregnancy status to ensure appropriate care and follow-up.

4. When to use HCPCS code G9997

HCPCS code G9997 should be used when the healthcare provider has documented the patient’s pregnancy status during the measurement period prior to and including the current encounter. It is important to use this code when the patient is pregnant to ensure accurate tracking and monitoring of their healthcare needs.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9997, healthcare providers need to ensure that they have documented the patient’s pregnancy status during the specified measurement period. The documentation should include the date of the encounter and the patient’s pregnancy status. This information is crucial for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9997 was added to the Healthcare Common Procedure Coding System on January 01, 2022. As of its addition, 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 for healthcare providers to stay updated on any changes or revisions to HCPCS codes to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

HCPCS code G9997 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 service is bundled or not covered separately. The multiple pricing indicator code is 9, which means that the value for this code is not established. Healthcare providers should refer to Medicare and insurance guidelines for specific coverage and reimbursement information.

8. Examples

Here are five examples of when HCPCS code G9997 should be billed:

1. A pregnant patient visits her obstetrician for a routine prenatal check-up. The provider documents the patient’s pregnancy status during the measurement period and includes HCPCS code G9997 in the billing.
2. A pregnant patient presents to the emergency department with abdominal pain. The healthcare provider evaluates the patient and documents her pregnancy status during the measurement period. HCPCS code G9997 is included in the billing for this encounter.
3. A pregnant patient undergoes a surgical procedure. The anesthesiologist documents the patient’s pregnancy status during the measurement period and includes HCPCS code G9997 in the anesthesia billing.
4. A pregnant patient receives a vaccination during a routine prenatal visit. The healthcare provider documents the patient’s pregnancy status during the measurement period and includes HCPCS code G9997 in the billing for the vaccination.
5. A pregnant patient visits a physical therapist for a prenatal exercise session. The therapist documents the patient’s pregnancy status during the measurement period and includes HCPCS code G9997 in the billing for the session.