How To Use HCPCS Code G8736

HCPCS code G8736 describes the most current LDL-C (low-density lipoprotein cholesterol) level being less than 100mg/dl. This code is used to indicate that a patient’s LDL-C level is below the recommended threshold, indicating a lower risk for cardiovascular disease.

1. What is HCPCS G8736?

HCPCS code G8736 is a specific code used in medical coding to identify the LDL-C level of a patient. LDL-C is a type of cholesterol that is often referred to as “bad” cholesterol because high levels can increase the risk of heart disease and stroke. This code is used to indicate that a patient’s LDL-C level is less than 100mg/dl, which is considered to be within the optimal range for cardiovascular health.

2. Official Description

The official description of HCPCS code G8736 is “Most current LDL-C <100mg/dl." This description clearly states that the code is used to indicate a LDL-C level below 100mg/dl.

3. Procedure

1. Obtain the patient’s LDL-C test results.
2. Determine the numerical value of the LDL-C level.
3. If the LDL-C level is less than 100mg/dl, assign HCPCS code G8736.
4. If the LDL-C level is equal to or greater than 100mg/dl, do not assign HCPCS code G8736.

4. When to use HCPCS code G8736

HCPCS code G8736 should be used when documenting a patient’s LDL-C level and it is less than 100mg/dl. This code is used to indicate that the patient’s LDL-C level is within the optimal range for cardiovascular health.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies associated with HCPCS code G8736, healthcare providers should ensure that the patient’s LDL-C test results are properly documented in the medical record. This documentation should include the numerical value of the LDL-C level and the date of the test. Additionally, providers should follow the appropriate billing guidelines set forth by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G8736 was added to the Healthcare Common Procedure Coding System on January 1, 2012. It has an effective date of January 1, 2015. This code is categorized as a “C” code, which means that coverage is determined by carrier judgment. There have been no maintenance actions taken for this code, as indicated by the action code “N,” which means no maintenance for this code. It is important for medical coders to stay updated on any changes or revisions to HCPCS codes to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

Medicare and other insurance carriers may provide coverage for services or supplies associated with HCPCS code G8736. The pricing indicator code for this code is “00,” which indicates that the service is not separately priced by Part B. This means that the service is either not covered, bundled, or used by Part A only. The multiple pricing indicator code is “9,” which means that the value is not established. It is important for healthcare providers to verify coverage and reimbursement policies with the specific insurance carrier to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G8736 should be billed:

1. A patient undergoes a lipid panel test, and the results show an LDL-C level of 85mg/dl. HCPCS code G8736 should be assigned to indicate the patient’s LDL-C level is less than 100mg/dl.
2. A patient’s LDL-C level is tested as part of a routine annual physical examination, and the results show an LDL-C level of 92mg/dl. HCPCS code G8736 should be assigned to indicate the patient’s LDL-C level is within the optimal range.
3. A patient with a history of high cholesterol undergoes a follow-up LDL-C test, and the results show an LDL-C level of 105mg/dl. HCPCS code G8736 should not be assigned as the LDL-C level is equal to or greater than 100mg/dl.
4. A patient with a family history of cardiovascular disease undergoes a lipid panel test, and the results show an LDL-C level of 78mg/dl. HCPCS code G8736 should be assigned to indicate the patient’s LDL-C level is below the recommended threshold.
5. A patient with diabetes undergoes a comprehensive metabolic panel, which includes an LDL-C test. The results show an LDL-C level of 97mg/dl. HCPCS code G8736 should be assigned to indicate the patient’s LDL-C level is less than 100mg/dl.