How To Use HCPCS Code G8697

HCPCS code G8697 describes the use of antithrombotic therapy not prescribed for documented reasons. This code is used to indicate situations where antithrombotic therapy, such as blood thinners, is not prescribed for specific reasons, such as a patient having a stroke during their hospital stay or the patient expiring during their inpatient stay. It can also be used when the patient leaves against medical advice or for other patient-related reasons.

1. What is HCPCS G8697?

HCPCS code G8697 is a specific code used in medical coding to identify instances where antithrombotic therapy is not prescribed for documented reasons. It helps healthcare providers and insurance companies track and categorize the use of antithrombotic therapy in patient care.

2. Official Description

The official description of HCPCS code G8697 is “Antithrombotic therapy not prescribed for documented reasons (e.g., patient had stroke during hospital stay, patient expired during inpatient stay, other medical reason(s)); (e.g., patient left against medical advice, other patient reason(s)).” The short description is “Antithromb no presc doc reas.”

3. Procedure

1. When using HCPCS code G8697, the healthcare provider should review the patient’s medical records and documentation to determine if there are any documented reasons for not prescribing antithrombotic therapy.
2. If there are documented reasons, such as the patient having a stroke during their hospital stay or the patient expiring during their inpatient stay, the healthcare provider should indicate this in the medical coding.
3. If there are other medical reasons or patient-related reasons for not prescribing antithrombotic therapy, these should also be documented and coded accordingly.

4. When to use HCPCS code G8697

HCPCS code G8697 should be used when antithrombotic therapy is not prescribed for documented reasons. This includes situations where the patient had a stroke during their hospital stay, the patient expired during their inpatient stay, or other medical reasons. It can also be used when the patient left against medical advice or for other patient-related reasons.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies related to HCPCS code G8697, healthcare providers need to ensure that the documentation clearly supports the reasons for not prescribing antithrombotic therapy. This may include medical records, progress notes, or other relevant documentation.

6. Historical Information and Code Maintenance

HCPCS code G8697 was added to the Healthcare Common Procedure Coding System on January 1, 2012. It has a termination date of December 31, 2017. This code has no maintenance actions, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G8697 may vary depending on the insurance provider. Medicare and other insurers may have specific guidelines and criteria for the use of this code. It is important for healthcare providers to check with the insurance company to determine if the service or supply related to this code is payable.

8. Examples

Here are five examples of when HCPCS code G8697 should be billed:

1. A patient had a stroke during their hospital stay, and antithrombotic therapy was not prescribed due to the stroke.
2. A patient expired during their inpatient stay, and antithrombotic therapy was not prescribed after their passing.
3. A patient left against medical advice, and antithrombotic therapy was not prescribed as a result.
4. A patient had other medical reasons documented that contraindicated the use of antithrombotic therapy.
5. A patient had other patient-related reasons for not receiving antithrombotic therapy, as documented in their medical records.