How To Use HCPCS Code G8627
HCPCS code G8627 describes a surgical procedure performed within 30 days following cataract surgery for major complications. This code is used to identify cases where patients experience complications such as retained nuclear fragments, endophthalmitis, dislocated or wrong power intraocular lens (IOL), retinal detachment, or wound dehiscence.
1. What is HCPCS G8627?
HCPCS code G8627 is a specific code used in medical coding to identify a surgical procedure performed within 30 days following cataract surgery for major complications. It allows healthcare providers to accurately document and bill for these services.
2. Official Description
The official description of HCPCS code G8627 is “Surgical procedure performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence)”. The short description for this code is “Surg proc w/in 30 days”.
3. Procedure
- The provider begins by assessing the patient’s condition and determining the need for surgical intervention following cataract surgery.
- If major complications such as retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence are identified, the provider decides to perform a surgical procedure.
- The surgical procedure is performed within 30 days following the initial cataract surgery.
- The provider follows standard surgical protocols and techniques to address the specific complication.
- After the procedure, the provider documents the details of the surgery, including any findings, techniques used, and any additional procedures performed.
4. When to use HCPCS code G8627
HCPCS code G8627 should be used when a surgical procedure is performed within 30 days following cataract surgery to address major complications. It is important to accurately document and code these services to ensure proper reimbursement and tracking of patient outcomes.
5. Billing Guidelines and Documentation Requirements
When billing for HCPCS code G8627, healthcare providers should ensure that the medical documentation supports the need for the surgical procedure and the presence of major complications. The documentation should include details such as the specific complication, the surgical approach used, and any additional procedures performed.
6. Historical Information and Code Maintenance
HCPCS code G8627 was added to the Healthcare Common Procedure Coding System on January 1, 2010. It has a pricing indicator code of 00, which indicates that the service is not separately priced by Part B. The code does not have a multiple pricing indicator code, as it is not priced separately by Part B.
7. Medicare and Insurance Coverage
Medicare and other insurance providers may cover the surgical procedure described by HCPCS code G8627 if the necessary criteria and documentation requirements are met. However, coverage and reimbursement may vary depending on the specific insurance plan and the patient’s individual circumstances. Providers should verify coverage with the relevant insurance companies before performing the procedure.
8. Examples
Here are five examples of when HCPCS code G8627 should be billed:
- A patient undergoes cataract surgery and develops endophthalmitis within 30 days. The provider performs a surgical procedure to address the infection.
- Following cataract surgery, a patient experiences a dislocated intraocular lens (IOL) within 30 days. The provider performs a surgical procedure to reposition the IOL.
- A patient undergoes cataract surgery and develops a retinal detachment within 30 days. The provider performs a surgical procedure to repair the detachment.
- After cataract surgery, a patient experiences wound dehiscence within 30 days. The provider performs a surgical procedure to close the wound.
- A patient undergoes cataract surgery and retains nuclear fragments within the eye within 30 days. The provider performs a surgical procedure to remove the fragments.
