How To Use HCPCS Code G2155

HCPCS code G2155 describes a patient who has a history of contraindications to the tdap vaccine, td vaccine, or its components, or encephalopathy due to tdap or td vaccination. This code is used to indicate that the patient has experienced anaphylaxis or encephalopathy as a result of these vaccinations.

1. What is HCPCS G2155?

HCPCS code G2155 is a specific code used in medical coding to identify patients who have a history of contraindications to certain vaccines. It is important for medical coders to accurately assign this code to ensure proper documentation and billing for patients with these specific conditions.

2. Official Description

The official description of HCPCS code G2155 is as follows: “Patient had history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis).” The short description for this code is “Hist contraindications.”

3. Procedure

1. During the coding process, the medical coder should review the patient’s medical records and identify any documented history of contraindications to the tdap vaccine, td vaccine, or its components, or encephalopathy due to tdap or td vaccination.
2. If the patient has a documented history of anaphylaxis due to the tdap vaccine, td vaccine, or its components, the medical coder should assign HCPCS code G2155.
3. If the patient has a documented history of encephalopathy due to tdap or td vaccination, such as post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis, or post pertussis vaccination encephalitis, the medical coder should also assign HCPCS code G2155.
4. It is important for the medical coder to accurately document the patient’s history of contraindications and ensure that the code is assigned correctly.

4. When to use HCPCS code G2155

HCPCS code G2155 should be used when a patient has a documented history of contraindications to the tdap vaccine, td vaccine, or its components, or encephalopathy due to tdap or td vaccination. This code is used to indicate that the patient has experienced anaphylaxis or encephalopathy as a result of these vaccinations.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G2155, healthcare providers should ensure that the patient’s medical records clearly document the history of contraindications or encephalopathy. This documentation should include specific details about the patient’s reaction to the vaccines and any associated symptoms or complications.

6. Historical Information and Code Maintenance

HCPCS code G2155 was added to the Healthcare Common Procedure Coding System on January 01, 2020. It has an effective date of January 01, 2021. As of December 31, 2020, this code has been terminated. No maintenance actions have been taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage for HCPCS code G2155 is determined by the carrier’s judgment. Medicare and other insurance providers may have specific guidelines and policies regarding the reimbursement for services or supplies associated with this code. It is important for healthcare providers to verify coverage and reimbursement policies with the respective payers.

8. Examples

Here are some examples of when HCPCS code G2155 should be billed:

1. A patient presents with a documented history of anaphylaxis due to the tdap vaccine. The medical coder assigns HCPCS code G2155 to indicate the patient’s contraindication to the vaccine.
2. Another patient has a documented history of encephalopathy following a td vaccination. The medical coder assigns HCPCS code G2155 to indicate the patient’s contraindication to the vaccine.
3. A third patient has a history of post pertussis vaccination encephalitis. The medical coder assigns HCPCS code G2155 to indicate the patient’s contraindication to the tdap vaccine.
4. Yet another patient has experienced anaphylaxis due to the components of the td vaccine. The medical coder assigns HCPCS code G2155 to indicate the patient’s contraindication to the vaccine.
5. Finally, a patient has a documented history of post tetanus vaccination encephalitis. The medical coder assigns HCPCS code G2155 to indicate the patient’s contraindication to the td vaccine.