G9219 – Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)

Long description

Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)

Short description

No oder pjp for med reason

Pricing indicator

00 Not separately priced by Part B (bundled, not covered or Part A only)

Medicare coverage

C Carrier judgment – coverage decided by the Medicare contractor

BETOS category

M5B Specialist - psychiatry

Added

January 1, 2014

Last change

January 1, 2017 – No change

Termination date

December 31, 2016

Nearby G codes

• G9211 – Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given
• G9212 – Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation
• G9213 – Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified
• G9214 – Cd4+ cell count or cd4+ cell percentage results documented
• G9215 – Cd4+ cell count or percentage not documented as performed, reason not given
• G9216 – Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
• G9217 – Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given
• G9218 – Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given
• G9220 – Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
• G9221 – Pneumocystis jiroveci pneumonia prophlaxis prescribed
• G9222 – Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3
• G9223 – Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
• G9224 – Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation)
• G9225 – Foot exam was not performed, reason not given
• G9226 – Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed)
• G9227 – Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter