Summary & Overview
HCPCS G9464: Completion of Sinusitis Quality Measures
HCPCS Level II code G9464 denotes that all required quality actions for the sinusitis measures group have been completed for an individual patient. The code is used to document fulfillment of quality measures tied to sinusitis care, signaling adherence to predefined clinical and documentation standards. Nationally, such codes matter because they support quality reporting, pay-for-performance programs, and population health measurement related to respiratory and ENT care.
Key payers commonly involved in coverage and reporting of quality codes include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn how this code is used in clinical documentation and quality reporting workflows, which payer groups commonly engage with such reporting, and the broader clinical context of sinusitis quality measures. The publication provides benchmarks and policy-relevant context where available, outlines common implementation considerations, and highlights how completion of measures is captured in claims for quality monitoring. Data not available in the input for specific modifiers, associated taxonomies, ICD-10 pairings, related codes, and service line are noted as unavailable.
Billing Code Overview
HCPCS Level II code G9464 indicates that all quality actions for the applicable measures in the sinusitis measures group have been performed for this patient. This reflects completion of required quality activities tied to a defined sinusitis measures set.
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Service type: Quality reporting / care quality measurement
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Typical site of service: Outpatient clinic, ambulatory care, or other settings where sinusitis diagnosis and related quality measures are assessed
Data not available in the input for modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A patient presents to a primary care clinic or otolaryngology (ENT) practice with symptoms consistent with acute or chronic sinusitis—facial pain/pressure, nasal congestion, purulent nasal discharge, and decreased sense of smell. The clinician documents diagnosis(es), completes the required quality measure actions for the applicable sinusitis measures group (e.g., assessment of symptom duration and severity, appropriate diagnostic testing, counseling on antibiotic use, documentation of watchful waiting or appropriate antibiotic selection when indicated, and patient education). The workflow typically includes history and physical exam, review of prior imaging or ordering of imaging if indicated, documentation of symptom onset and prior treatments, shared decision-making about antibiotics, and counseling on supportive care. Once all quality actions for the applicable sinusitis measures group are performed and documented for the patient encounter, the practice reports the HCPCS Level II code G9464 to indicate completion of all measure components for that patient during the performance period.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
24 | Unrelated Evaluation and Management service by the same physician or other qualified health care professional during a postoperative period | Use when a separate E/M for sinusitis quality measures is provided unrelated to the postoperative care of a prior procedure |
25 | Significant, separately identifiable E/M service by the same physician on the same day of a procedure or other service | Use when a distinct E/M visit includes completion of sinusitis quality actions in addition to another same-day service |
57 | Decision for surgery | Use if documentation shows decision for ENT surgery during the encounter while quality measures were performed |
59 | Distinct procedural service | Use when another procedural service is separately reportable and distinct from the quality-measure documentation encounter |
76 | Repeat procedure or service by same physician | Use when the same quality-action reporting occurs again during the same global period and must be distinguished |
77 | Repeat procedure by another physician | Use when another clinician repeats a service related to sinus evaluation and documentation |
78 | Unplanned return to the operating room by the same physician following initial procedure | Use only if a postoperative complication required return and concurrent quality-measure documentation is reported |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when quality-measure documentation is unrelated to the postoperative care |
90 | Reference (Outside) Laboratory | Use when external laboratory testing contributed to diagnostic actions documented in the quality measures |
91 | Repeat clinical diagnostic test same day to confirm results | Use when repeat testing was required and documented as part of measure completion |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207Q00000X | Otolaryngology | ENT specialists commonly evaluate and manage sinusitis and perform measure documentation |
207R00000X | Family Medicine | Primary care clinicians frequently diagnose sinusitis and complete quality-measure actions |
207RG0300X | Internal Medicine | Internists manage sinusitis in outpatient settings and document quality actions |
363A00000X | Nurse Practitioner | NPs in primary care or ENT clinics often perform the clinical assessment and documentation |
367500000X | Physician Assistant | PAs assist in evaluation, treatment decisions, and documentation of quality measures |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
J01.90 | Acute sinusitis, unspecified | Common acute presentation prompting completion of sinusitis quality measures |
J01.90 | Acute sinusitis, unspecified | Used when acute sinusitis is diagnosed and measure actions (antibiotic stewardship, counseling) are completed |
J32.9 | Chronic sinusitis, unspecified | Indicates chronic disease requiring comprehensive documentation of prior treatments and management measures |
J01.00 | Acute maxillary sinusitis, unspecified | Specific anatomic diagnosis that guides diagnostic actions and treatment decisions documented in measures |
J01.10 | Acute frontal sinusitis, unspecified | Anatomic variant relevant to imaging and management decisions captured in quality measures |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | Common E/M code used when documenting sinusitis evaluation and completion of quality actions during a routine visit |
99214 | Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes | Used when the sinusitis visit is more complex, requiring detailed history, exam, and counseling to complete measure requirements |
31231 | Nasal/sinus endoscopy, diagnostic, unilateral or bilateral (separate procedure) | Performed when direct endoscopic assessment is needed to support diagnostic actions documented in measures |
70486 | Computed tomography, maxillofacial area; without contrast material | Imaging often ordered to evaluate complicated or chronic sinusitis as part of completing diagnostic measure elements |
87070 | Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates | Microbiologic testing sometimes used to guide antibiotic selection and documented within quality actions |