How To Use HCPCS Code G8586

HCPCS code G8586 describes a specific medical situation where anti-lipid treatment is contraindicated. This code is used to indicate that a patient should not receive treatment for lipid disorders due to certain circumstances or conditions. In this article, we will explore the details of HCPCS code G8586, 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 G8586?

HCPCS code G8586 is a specific code used in medical coding to identify situations where anti-lipid treatment is contraindicated. It is important for medical coders to accurately assign this code to ensure proper documentation and billing for patients who should not receive lipid-lowering treatment.

2. Official Description

The official description of HCPCS code G8586 is “Anti-lipid treatment contraindicated.” This description clearly indicates that this code is used when it is not appropriate or advisable to administer anti-lipid treatment to a patient.

3. Procedure

1. When HCPCS code G8586 is assigned, the healthcare provider should document the specific reasons why anti-lipid treatment is contraindicated for the patient.
2. The provider should also document any alternative treatment options or recommendations for managing the patient’s lipid disorder.
3. It is important to accurately document the patient’s medical history, current medications, and any other relevant information that supports the decision to contraindicate anti-lipid treatment.

4. When to use HCPCS code G8586

HCPCS code G8586 should be used when a patient’s medical condition or circumstances make it inappropriate or unsafe to administer anti-lipid treatment. This could include situations where the patient has a known allergy or adverse reaction to lipid-lowering medications, or if the patient has a medical condition that contraindicates the use of these treatments.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies related to HCPCS code G8586, healthcare providers should ensure that the medical documentation clearly supports the decision to contraindicate anti-lipid treatment. This documentation should include the patient’s medical history, any relevant test results, and the provider’s clinical judgment regarding the appropriateness of anti-lipid treatment.

6. Historical Information and Code Maintenance

HCPCS code G8586 was terminated on December 31, 2014. This means that it is no longer an active code in the Healthcare Common Procedure Coding System. It is important for medical coders to be aware of this termination date and use the appropriate replacement code, if applicable.

7. Medicare and Insurance Coverage

HCPCS code G8586 is assigned a pricing indicator code of 00, which indicates that the service or supply is not separately priced by Part B. This means that it may be bundled with other services or not covered by Medicare. It is important for healthcare providers to check with Medicare and other insurance providers to determine coverage and reimbursement for services related to HCPCS code G8586.

8. Examples

Here are five examples of when HCPCS code G8586 should be billed:

1. A patient with a severe allergy to lipid-lowering medications.
2. A patient with a history of adverse reactions to anti-lipid treatment.
3. A patient with a medical condition that contraindicates the use of lipid-lowering medications.
4. A patient who is pregnant and should not receive anti-lipid treatment due to potential risks to the fetus.
5. A patient who is unable to tolerate lipid-lowering medications due to significant side effects.