Question 1

What is HCPCS code G2097?

Accepted Answer

HCPCS code G2097 is "Dx uri 3d after other dx". Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti)

Question 2

What category is G2097 in?

Accepted Answer

G2097 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G2097?

Accepted Answer

Use G2097 when billing for dx uri 3d after other dx. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G2097 covered by Medicare?

Accepted Answer

Coverage for G2097 (Dx uri 3d after other dx) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G2097?

Accepted Answer

Documentation for G2097 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).