How To Use HCPCS Code G8845

HCPCS code G8845 describes the use of positive airway pressure therapy that is prescribed by a healthcare provider. This code is used to identify the specific service of prescribing and recommending the use of positive airway pressure therapy for patients. In this article, we will explore the details of HCPCS code G8845, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G8845?

HCPCS code G8845 is used to identify the service of prescribing positive airway pressure therapy. This therapy is commonly used to treat sleep apnea, a condition where a person’s breathing is interrupted during sleep. Positive airway pressure therapy involves the use of a machine that delivers a continuous flow of air through a mask, helping to keep the airway open and prevent interruptions in breathing.

2. Official Description

The official description of HCPCS code G8845 is “Positive airway pressure therapy prescribed.” The short description is “Pos airway press prescribed.” This description accurately reflects the purpose of the code, which is to identify the service of prescribing positive airway pressure therapy.

3. Procedure

1. The healthcare provider evaluates the patient’s symptoms and medical history to determine if positive airway pressure therapy is appropriate.
2. If positive airway pressure therapy is deemed necessary, the provider discusses the treatment options with the patient.
3. The provider prescribes the specific type of positive airway pressure therapy and provides instructions on how to use the equipment.
4. The patient may be referred to a durable medical equipment supplier to obtain the necessary equipment.
5. Follow-up appointments may be scheduled to monitor the patient’s progress and make any necessary adjustments to the therapy.

4. When to use HCPCS code G8845

HCPCS code G8845 should be used when a healthcare provider prescribes positive airway pressure therapy for a patient. This code is applicable when the provider recommends the use of this therapy to treat sleep apnea or other respiratory conditions that can benefit from positive airway pressure.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8845, healthcare providers should ensure that the following documentation is included:

• A detailed description of the patient’s symptoms and medical history supporting the need for positive airway pressure therapy.
• The provider’s prescription for the specific type of positive airway pressure therapy.
• Documentation of any discussions with the patient regarding the treatment options and instructions on how to use the equipment.
• Any follow-up notes or adjustments made to the therapy during subsequent appointments.

6. Historical Information and Code Maintenance

HCPCS code G8845 was added to the Healthcare Common Procedure Coding System on January 01, 2012. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This suggests that the code has remained unchanged since its introduction.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G8845 may vary depending on the specific insurance provider. Medicare coverage for positive airway pressure therapy is typically available for patients who meet certain criteria, such as a diagnosis of sleep apnea and documentation of the medical necessity for the therapy. It is important for healthcare providers to verify the coverage and reimbursement policies of each insurance provider before billing for this service.

8. Examples

Here are five examples of when HCPCS code G8845 should be billed:

1. A patient with a diagnosis of moderate to severe sleep apnea is prescribed positive airway pressure therapy by their sleep specialist.
2. A patient with chronic obstructive pulmonary disease (COPD) is prescribed positive airway pressure therapy to help manage their respiratory symptoms.
3. A patient undergoes a sleep study and is diagnosed with obstructive sleep apnea. The healthcare provider prescribes positive airway pressure therapy as part of their treatment plan.
4. A patient with a history of snoring and daytime sleepiness undergoes a sleep evaluation and is recommended positive airway pressure therapy by their healthcare provider.
5. A patient with a diagnosis of central sleep apnea is prescribed positive airway pressure therapy to help regulate their breathing during sleep.