HCPCS Service Codes - Medical care

HCPCS Codes for Medical care

• G9360

  No documentation of negative or managed positive tb screen

• G9361

  Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)]

• G9362

  Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure 60 minutes or longer, as documented in the anesthesia record

• G9363

  Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record

• G9364

  Sinusitis caused by, or presumed to be caused by, bacterial infection

• G9365

  One high-risk medication ordered

• G9366

  One high-risk medication not ordered

• G9367

  At least two orders for high-risk medications from the same drug class

• G9368

  At least two orders for high-risk medications from the same drug class not ordered

• G9369

  Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater

• G9370

  Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater

• G9376

  Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery

• G9377

  Patient did not have the retina attached after 6 months following only one surgery

• G9378

  Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month)

• G9379

  Patient did not achieve flat retinas six months post surgery

• G9380

  Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period

• G9381

  Documentation of medical reason(s) for not offering assistance with end of life issues (e.g., patient in hospice care, patient in terminal phase) during the measurement period

• G9382

  Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period

• G9383

  Patient received screening for hcv infection within the 12 month reporting period

• G9384

  Documentation of medical reason(s) for not receiving annual screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons)

• G9385

  Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons)

• G9386

  Screening for hcv infection not received within the 12 month reporting period, reason not given

• G9389

  Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery

• G9390

  No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery

• G9391

  Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit

• G9392

  Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit

• G9393

  Patient with an initial phq-9 score greater than nine who achieves remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score of less than five

• G9394

  Patient who had a diagnosis of bipolar disorder or personality disorder, death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement or assessment period

• G9395

  Patient with an initial phq-9 score greater than nine who did not achieve remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score greater than or equal to five

• G9396

  Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days)

• G9399

  Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment

• G9400

  Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons

• G9401

  No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment

• G9402

  Patient received follow-up within 30 days after discharge

• G9403

  Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up)

• G9404

  Patient did not receive follow-up within 30 days after discharge

• G9405

  Patient received follow-up within 7 days after discharge

• G9406

  Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up)

• G9407

  Patient did not receive follow-up within 7 days after discharge

• G9408

  Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days

• G9409

  Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days

• G9410

  Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision

• G9411

  Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision

• G9412

  Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision

• G9413

  Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision

• G9414

  Patient had one dose of meningococcal vaccine (serogroups a, c, w, y or a, c, w, y, b) on or between the patient's 10th and 13th birthdays

• G9415

  Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y or a, c, w, y, b), on or between the patient's 10th and 13th birthdays

• G9416

  Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays

• G9417

  Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays

• G9418

  Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation