How To Use HCPCS Code G8737

HCPCS code G8737 describes the most current LDL-C (low-density lipoprotein cholesterol) level of greater than or equal to 100mg/dL. This code is used to identify patients who have LDL-C levels that meet or exceed the specified threshold.

1. What is HCPCS G8737?

HCPCS code G8737 is a specific code used in medical coding to identify patients with LDL-C levels of 100mg/dL or higher. It is important for healthcare providers to accurately assign this code to ensure proper documentation and billing for patients who meet the specified LDL-C level.

2. Official Description

The official description of HCPCS code G8737 is “Most current LDL-C >=100mg/dL.” This description clearly indicates that the code is used to identify patients with LDL-C levels that meet or exceed 100mg/dL.

3. Procedure

1. Obtain the patient’s LDL-C test results.
2. Determine if the LDL-C level is equal to or greater than 100mg/dL.
3. If the LDL-C level meets or exceeds 100mg/dL, assign HCPCS code G8737 to indicate the patient’s LDL-C status.

4. When to use HCPCS code G8737

HCPCS code G8737 should be used when documenting and billing for patients who have LDL-C levels of 100mg/dL or higher. It is important to use this code accurately to ensure proper reimbursement and to provide a clear indication of the patient’s LDL-C status.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G8737, healthcare providers should ensure that the patient’s LDL-C test results are properly documented in the medical record. This documentation should include the date of the test, the LDL-C level, and any relevant clinical information. When billing for services related to LDL-C management, providers should follow the appropriate coding and billing guidelines set forth by Medicare or other insurance payers.

6. Historical Information and Code Maintenance

HCPCS code G8737 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 indicates 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.

7. Medicare and Insurance Coverage

Medicare and other insurance payers may provide coverage for services related to LDL-C management, including those identified by HCPCS code G8737. 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 may be bundled or not covered by Medicare. The multiple pricing indicator code is 9, which indicates that the value is not established or not applicable as HCPCS is not priced separately by Part B. It is important for healthcare providers to verify coverage and reimbursement policies with the specific payer.

8. Examples

Here are five examples of when HCPCS code G8737 should be billed:

1. A patient’s LDL-C test results indicate a level of 105mg/dL.
2. A patient’s LDL-C test results indicate a level of 115mg/dL.
3. A patient’s LDL-C test results indicate a level of 100mg/dL.
4. A patient’s LDL-C test results indicate a level of 120mg/dL.
5. A patient’s LDL-C test results indicate a level of 130mg/dL.