How To Use HCPCS Code G0028

HCPCS code G0028 describes the documentation of medical reasons for not screening for tobacco use. This code is used when a healthcare provider determines that it is not appropriate or necessary to screen a patient for tobacco use due to certain medical reasons. In this article, we will explore the details of HCPCS code G0028, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0028?

HCPCS code G0028 is used to document the medical reason(s) for not screening for tobacco use. It is important for healthcare providers to accurately document the reasons why a patient was not screened for tobacco use, as this information is crucial for patient care and reimbursement purposes.

2. Official Description

The official description of HCPCS code G0028 is “Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)”. The short description for this code is “Doc med rsn no scr tob”.

3. Procedure

1. When a healthcare provider determines that it is not appropriate or necessary to screen a patient for tobacco use, they should document the specific medical reason(s) for not conducting the screening.
2. The documentation should clearly state the medical reason(s) for not screening, such as limited life expectancy or other medical conditions that make the screening unnecessary or contraindicated.
3. It is important to provide detailed and accurate documentation to support the medical decision of not screening for tobacco use.

4. When to use HCPCS code G0028

HCPCS code G0028 should be used when a healthcare provider determines that it is not appropriate or necessary to screen a patient for tobacco use due to specific medical reasons. Some examples of medical reasons for not screening may include:

• Patients with limited life expectancy
• Patients with severe medical conditions that make the screening unnecessary or contraindicated
• Patients who are unable to provide informed consent for the screening

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0028, healthcare providers should ensure that the documentation supports the medical reason(s) for not screening for tobacco use. The documentation should clearly state the specific medical reason(s) and provide sufficient details to justify the decision.

6. Historical Information and Code Maintenance

HCPCS code G0028 was terminated on December 31, 2022. This means that it is no longer valid for use in medical coding and billing. The termination date indicates that there have been changes or updates to the code, and it is no longer in use as of January 1, 2023.

7. Medicare and Insurance Coverage

HCPCS code G0028 is covered by Medicare and other insurance providers. However, it is important to check with individual payers for specific coverage and reimbursement guidelines. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the service may be bundled or not covered separately.

8. Examples

Here are some examples of when HCPCS code G0028 should be billed:

1. A patient with a terminal illness and limited life expectancy is not screened for tobacco use.
2. A patient with a severe medical condition that makes the screening unnecessary is not screened for tobacco use.
3. A patient who is unable to provide informed consent for the screening is not screened for tobacco use.
4. A patient with a documented medical reason for not screening for tobacco use, such as a known allergy to the screening test.
5. A patient who has already been screened for tobacco use within a specified time frame and does not require additional screening.