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Quality Data G-Codes

ASCs are required to report quality data G-codes on five measures or face Medicare payment reductions. ASCs must include the G-code corresponding to the Medicare patient’s experience under the procedure code(s) in box 24 D of the CMS-1500 claim form. ASCs are considered successful reporters on these measures if 50 percent of their Medicare claims during the year contain quality data G-codes. While CMS has indicated that this percentage may increase in future years, for the 2014 reporting period it remains at 50 percent. ASCs must include the G-codes on claims where Medicare is either the primary or secondary payer.

The number of G-codes reported on the claim form will always be either two or five:

  • One G-code that corresponds to the patient’s experience with prophylactic IV antibiotic will be reported on all claims.

  • An additional G-code, G-8907, will be reported if the patient does not experience any of the four specific adverse events (patient burn, patient fall, wrong site/side/patient/procedure/implant and hospital transfer/admission).

  • An additional four G-codes, each corresponding to one of the four specific adverse events, will be reported if the patient does experience one or more of the adverse events.

ASCs that experience problems with using these codes should email ASCA.

Download a G-codes Cheat Sheet

Download a Sample CMS-1500 Claim Form


Corresponding Quality Measure

G-code

Description

All

G8907

Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility.

Patient burn

G8908

Patient documented to have received a burn prior to discharge

Patient burn

G8909

Patient documented not to have received a burn prior to discharge

Patient fall in ASC facility

G8910

Patient documented to have experienced a fall within the ASC

Patient fall in ASC facility

G8911

Patient documented not to have experienced a fall within the ASC

Wrong site, wrong side, wrong patient, wrong procedure, wrong implant

G8912

Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event

Wrong site, wrong side, wrong patient, wrong procedure, wrong implant

G8913

Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event

Hospital transfer/Admission

G8914

Patient documented to have experienced a hospital transfer or hospital admission upon discharge from ASC

Hospital transfer/Admission

G8915

Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from ASC

Timing of Prophylactic Antibiotic Administration

G8916

Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic initiated on time

Timing of Prophylactic IV Antibiotic Administration

G8917

Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic not initiated on time

Timing of Prophylactic IV Antibiotic Administration

G8918

Patient without preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis