HCPCS Service Codes - Medical care

HCPCS Codes for Medical care

• G9486

  Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology

• G9487

  Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology

• G9488

  Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology

• G9489

  Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved coms innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology

• G9490

  Cms innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved cms innovation center models); may not be billed for a 30 day period covered by a transitional care management code

• G9496

  Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma

• G9497

  Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery

• G9498

  Antibiotic regimen prescribed

• G9499

  Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period

• G9500

  Radiation exposure indices documented in final report for procedure using fluoroscopy

• G9501

  Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given

• G9502

  Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period)

• G9503

  Patient taking tamsulosin hydrochloride

• G9504

  Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy

• G9505

  Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason

• G9506

  Biologic immune response modifier prescribed

• G9507

  Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)

• G9508

  Documentation that the patient is not on a statin medication

• G9509

  Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5

• G9510

  Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5

• G9511

  Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period

• G9512

  Individual had a pdc of 0.8 or greater

• G9513

  Individual did not have a pdc of 0.8 or greater

• G9514

  Patient required a return to the operating room within 90 days of surgery

• G9515

  Patient did not require a return to the operating room within 90 days of surgery

• G9516

  Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery

• G9517

  Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given

• G9518

  Documentation of active injection drug use

• G9519

  Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery

• G9520

  Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery

• G9521

  Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months

• G9522

  Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given

• G9523

  Patient discontinued from hemodialysis or peritoneal dialysis

• G9524

  Patient was referred to hospice care

• G9525

  Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)

• G9526

  Patient was not referred to hospice care, reason not given

• G9529

  Patient with minor blunt head trauma had an appropriate indication(s) for a head ct

• G9530

  Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider

• G9531

  Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar

• G9532

  Patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma

• G9533

  Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct

• G9534

  Advanced brain imaging (cta, ct, mra or mri) was not ordered

• G9535

  Patients with a normal neurological examination

• G9536

  Documentation of medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures, or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); hiv-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms)

• G9537

  Imaging needed as part of a clinical trial; or other clinician ordered the study

• G9538

  Advanced brain imaging (cta, ct, mra or mri) was ordered

• G9539

  Intent for potential removal at time of placement

• G9540

  Patient alive 3 months post procedure

• G9541

  Filter removed within 3 months of placement

• G9542

  Documented re-assessment for the appropriateness of filter removal within 3 months of placement