How To Use HCPCS Code G8601

HCPCS code G8601 describes the situation where intravenous thrombolytic therapy is not initiated within 4.5 hours (<= 270 minutes) of the time the patient was last known to be well, due to reasons documented by the clinician. This code is used to indicate that the patient was not eligible for tissue plasminogen activator (tPA) treatment within the recommended time frame for various reasons, such as the patient being enrolled in a clinical trial for stroke or being admitted for elective carotid intervention.

1. What is HCPCS G8601?

HCPCS code G8601 is a specific code used in medical coding to identify the situation where intravenous thrombolytic therapy is not initiated within 4.5 hours of the patient’s last known well time. It is important to accurately assign this code to ensure proper documentation and billing for the services provided.

2. Official Description

The official description of HCPCS code G8601 is “Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention)." The short description for this code is "No elig tpa init w/in 4.5 hr."

3. Procedure

1. The provider assesses the patient’s eligibility for intravenous thrombolytic therapy within 4.5 hours of the time the patient was last known to be well.
2. If the patient meets the eligibility criteria, the provider initiates the intravenous thrombolytic therapy within the recommended time frame.
3. If the patient does not meet the eligibility criteria, the provider documents the reasons for not initiating the therapy within 4.5 hours.

4. When to use HCPCS code G8601

HCPCS code G8601 should be used when the patient is not eligible for intravenous thrombolytic therapy within 4.5 hours of the time they were last known to be well. This may be due to various reasons, such as the patient being enrolled in a clinical trial for stroke or being admitted for elective carotid intervention. It is important to accurately document the reasons for not initiating the therapy within the recommended time frame.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8601, healthcare providers need to ensure proper documentation of the reasons for not initiating intravenous thrombolytic therapy within 4.5 hours. This documentation should be detailed and support the medical necessity of the decision. Additionally, providers should follow the billing guidelines set forth by the relevant payers to ensure accurate and timely reimbursement for the services provided.

6. Historical Information and Code Maintenance

HCPCS code G8601 was added to the Healthcare Common Procedure Coding System on January 01, 2010. As of January 01, 2024, there has been a change in the long description of the procedure or modifier code associated with this HCPCS code. The pricing indicator code for G8601 is 00, indicating that the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value is not established for this code. There have been no other maintenance actions taken for this code.

7. Medicare and Insurance Coverage

Medicare coverage for HCPCS code G8601 is determined by carrier judgment (coverage code C). The service or supply represented by this code may or may not be covered by Medicare or other insurance providers. Providers should refer to the specific guidelines and policies of the relevant payers to determine coverage and reimbursement for the services provided.

8. Examples

Here are five examples of when HCPCS code G8601 should be billed:

1. A patient is enrolled in a clinical trial for stroke and is not eligible for intravenous thrombolytic therapy within 4.5 hours of the time they were last known to be well.
2. A patient is admitted for elective carotid intervention and is not eligible for intravenous thrombolytic therapy within 4.5 hours of the time they were last known to be well.
3. A patient has a documented contraindication to intravenous thrombolytic therapy and is not eligible for treatment within the recommended time frame.
4. A patient presents with symptoms of stroke but exceeds the 4.5-hour window for eligibility for intravenous thrombolytic therapy.
5. A patient’s last known well time cannot be accurately determined, and therefore, they are not eligible for intravenous thrombolytic therapy within the recommended time frame.