Wiki GXXXX5

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Hi there, could you provide the descriptor? That isn't a valid code, it's a placeholder code that CMS issues before it creates the final code.
 
Hi There Heatherbee
I' d use dx related to skin problem L27, L98, R21 etc. since derm /skin problem with Eval Mgnt code and Z59 or Z60.3 as last dx code.
It seems GXXXs seems to be for mental health assessment 96160-96127 which fits supported documentation . See info below on GXXX5

New HCPCS G-code for SDOH Data Collection​

CMS proposes to establish a new HCPCS code, GXXX5, that would allow practitioners to bill Medicare for administering a standardized SDOH screening tool during certain E/M visits.

The full proposed descriptor for GXXX5 is: “Administration of a standardized, evidence-based Social Determinants of Health Risk Assessment tool, 5-15 minutes.” CMS proposes that GXXX5 would be billable when at least five minutes is spent administering a structured, evidence-based SDOH screening tool as part of an E/M visit.

CMS believes this code will improve consistent screening and documentation of SDOH data in the medical record. This data then can inform patient diagnoses, care planning, and coordination.
CMS identified seven SDOH domains that screening tools can address:
  1. Economic stability.
  2. Education
  3. Health care access and quality.
  4. Neighborhood and environment.
  5. Food
  6. Community and social context.
  7. Social relationships.
The code would be reportable only with E/M visits and could not be billed if the screening time is already included in the time and work of the E/M code. CMS proposes a work RVU of 0.33 for GXXX5 based on a direct crosswalk to CPT code 96160 (Administration of patient-focused health risk assessment instrument), which has the same time values.

I hope helped you :)
Lady T

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Oh, it is the SDOH assesment code. That will be G0136 (Administration of a standardized, evidence-based Social Determinants of Health Risk Assessment tool, 5-15 minutes)

It isn't specialty-specific but the provider must determine whether the risk assessment is appropriate on a patient-by-patient basis.

According to the final rule, the provider must have “reason to believe there are unmet SDOH needs that are interfering with the practitioner’s diagnosis and treatment of a condition or illness.”

For example, if the dermatologist instructs the patient to keep a medicine refrigerated and the patient says they the power has been cut off at their home.

In addition to performing the assessment the provider must document that they did something with the results. For example, they referred the patient to an organization that helps people cover the cost of utilities. According to the final rule:

“We do expect that the practitioner furnishing an SDOH risk assessment would, at a minimum, refer the patient to relevant resources and take into account the results of the assessment in their medical decision making, or diagnosis and treatment plan for the visit."
Click to expand...

CMS will not require a SDOH ICD-10-CM code, but encourages practices to use them when appropriate.

In the final rule CMS said that while it expects that the service will usually be performed in conjunction with an E/M visit such as an office/outpatient visit, the annual wellness visit and various behavioral health services, it will not require them to be on the same day.

However, the practice must document that it had reason to believe the patient needed the assessment before the appointment. For example, if it is difficult to schedule an appointment because the patient doesn't have reliable transportation.
 
CMS articles state that a 33 modifer is appropriate for G0136 yet my claims to Medicare advantage plans are denying as inappropriate modifier. Can anyone advise?
 
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