How To Use HCPCS Code G8635
HCPCS code G8635 describes a situation where pharmacologic therapy for osteoporosis was not prescribed, and the reason for not prescribing it is not given. This code falls under the category of “No pharm ther osteo rx” and is used to indicate that a patient did not receive any pharmacologic treatment for osteoporosis, without any specific reason provided.
1. What is HCPCS G8635?
HCPCS code G8635 is a specific code used in medical coding to identify cases where pharmacologic therapy for osteoporosis was not prescribed, and the reason for not prescribing it is not given. It is important to note that this code does not provide any information about the patient’s condition or the healthcare provider’s decision-making process. It simply indicates the absence of pharmacologic treatment for osteoporosis without any specific reason provided.
2. Official Description
The official description of HCPCS code G8635 is “Pharmacologic therapy for osteoporosis was not prescribed, reason not given.” The short description for this code is “No pharm ther osteo rx.”
3. Procedure
- There is no specific procedure associated with HCPCS code G8635, as it only indicates the absence of pharmacologic therapy for osteoporosis without any specific reason provided.
4. When to use HCPCS code G8635
HCPCS code G8635 should be used when documenting cases where pharmacologic therapy for osteoporosis was not prescribed, and the reason for not prescribing it is not given. It is important to accurately capture this information in medical coding to ensure proper documentation and billing.
5. Billing Guidelines and Documentation Requirements
When using HCPCS code G8635, healthcare providers need to document the absence of pharmacologic therapy for osteoporosis and the lack of a specific reason for not prescribing it. This information should be included in the patient’s medical records for accurate billing and documentation purposes.
6. Historical Information and Code Maintenance
HCPCS code G8635 was added to the Healthcare Common Procedure Coding System on January 01, 2011. It has an action effective date of January 01, 2013, indicating that it has been in use since then. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.
7. Medicare and Insurance Coverage
HCPCS code G8635 falls under the coverage code C, which indicates that coverage is determined by carrier judgment. This means that Medicare or other insurance providers will make a decision on whether to cover the specific case based on their own guidelines and policies. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This could be due to various reasons, such as the service not being covered, bundled with other services, or only used by Part A. The multiple pricing indicator code is 9, which means that the value is not established or applicable for this code.
8. Examples
Here are five examples of when HCPCS code G8635 should be billed:
- A patient with a diagnosis of osteoporosis did not receive any pharmacologic therapy for the condition, and no specific reason was provided in the medical records.
- A healthcare provider determined that the patient’s osteoporosis did not require pharmacologic treatment, and the reason for this decision was not documented.
- A patient declined pharmacologic therapy for osteoporosis, but no specific reason for the refusal was recorded.
- A healthcare provider did not prescribe any pharmacologic therapy for osteoporosis due to the patient’s underlying medical conditions, but this reason was not documented.
- A patient’s osteoporosis was managed through non-pharmacologic means, and no specific reason for not prescribing pharmacologic therapy was provided.
