How To Use HCPCS Code G8602

HCPCS code G8602 describes the situation where intravenous thrombolytic therapy is not initiated within 4.5 hours (270 minutes) of the patient’s last known well time, and the reason for not initiating the therapy is not given. This code is used to indicate that the patient did not receive tissue plasminogen activator (TPA) within the recommended time frame for treatment of certain medical conditions.

1. What is HCPCS G8602?

HCPCS code G8602 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, and the reason for not initiating the therapy is not given. This code helps healthcare providers and insurance companies track and document instances where the recommended treatment protocol was not followed.

2. Official Description

The official description of HCPCS code G8602 is “Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given." The short description is "No tpa init w/in 4.5 hr." This description accurately reflects the meaning and purpose of the code.

3. Procedure

1. The healthcare provider assesses the patient’s medical history and determines the last known well time.
2. If the patient meets the criteria for thrombolytic therapy, the provider should initiate the treatment within 4.5 hours of the last known well time.
3. If the therapy is not initiated within the recommended time frame, HCPCS code G8602 should be used to indicate this situation.
4. The reason for not initiating the therapy should be documented in the patient’s medical records.

4. When to use HCPCS code G8602

HCPCS code G8602 should be used when the patient does not receive intravenous thrombolytic therapy within 4.5 hours of their last known well time, and the reason for not initiating the therapy is not given. This code is specific to situations where the recommended treatment protocol is not followed, and the reason for the deviation is not documented.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8602, healthcare providers should ensure that the medical documentation clearly states the patient’s last known well time, the decision not to initiate thrombolytic therapy within the recommended time frame, and the reason for not initiating the therapy. This information is crucial for accurate coding and billing.

6. Historical Information and Code Maintenance

HCPCS code G8602 was added to the Healthcare Common Procedure Coding System on January 01, 2010. As of January 01, 2023, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has a pricing indicator code of 00, which means it is not separately priced by Part B. It is important for medical coders to stay updated on any changes or revisions to the code.

7. Medicare and Insurance Coverage

Medicare and other insurance companies may provide coverage for the services or supplies associated with HCPCS code G8602. However, the pricing indicator code for this code is 00, which indicates that it is not separately priced by Part B. This means that the service or supply may be bundled or not covered by Medicare or other insurers. It is important for healthcare providers to verify coverage and reimbursement policies with the respective payers.

8. Examples

Here are five examples of when HCPCS code G8602 should be billed:

1. A patient arrives at the emergency department with stroke symptoms but does not receive thrombolytic therapy within the recommended time frame due to contraindications.
2. A patient presents with a myocardial infarction but does not receive thrombolytic therapy within 4.5 hours of the last known well time due to delayed presentation.
3. A patient is eligible for thrombolytic therapy but refuses the treatment within the recommended time frame.
4. A patient with a pulmonary embolism does not receive thrombolytic therapy within the recommended time frame due to the unavailability of the medication.
5. A patient with a deep vein thrombosis does not receive thrombolytic therapy within 4.5 hours of the last known well time due to the presence of a bleeding disorder.