How To Use HCPCS Code G8850

HCPCS code G8850 describes a situation where positive airway pressure therapy is not prescribed, and the reason for not prescribing it is not given. This code is used to indicate that a patient is not receiving positive airway pressure therapy, such as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP), and there is no specific reason documented for this decision.

1. What is HCPCS G8850?

HCPCS code G8850 is a specific code used in medical coding to identify the absence of a prescription for positive airway pressure therapy, without a documented reason. It is important to note that this code does not provide any information about the underlying medical condition or the decision-making process behind the lack of prescription. It simply indicates that the therapy is not prescribed and the reason is not given.

2. Official Description

The official description of HCPCS code G8850 is “Positive airway pressure therapy not prescribed, reason not given.” This description clearly states that the code is used when positive airway pressure therapy is not prescribed, and there is no documented reason for this decision.

3. Procedure

1. When using HCPCS code G8850, the healthcare provider should review the patient’s medical records and confirm that positive airway pressure therapy has not been prescribed.
2. The provider should ensure that there is no documented reason for the absence of prescription, such as patient preference, contraindications, or alternative treatment plans.
3. If the provider determines that positive airway pressure therapy is not prescribed and there is no documented reason, they can assign HCPCS code G8850 to accurately reflect this information in the medical coding.

4. When to use HCPCS code G8850

HCPCS code G8850 should be used when positive airway pressure therapy, such as CPAP or BiPAP, is not prescribed for a patient, and there is no documented reason for this decision. It is important to note that this code should only be used when there is no specific reason given for the absence of prescription. If there is a documented reason, a different HCPCS code should be used to accurately reflect the situation.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies related to HCPCS code G8850, healthcare providers should ensure that the absence of positive airway pressure therapy prescription is clearly documented in the patient’s medical records. This documentation should include the date of the assessment or evaluation, the provider’s determination that therapy is not prescribed, and the absence of any documented reason for this decision.

6. Historical Information and Code Maintenance

HCPCS code G8850 was added to the Healthcare Common Procedure Coding System on January 1, 2012. It has an action code of N, indicating no maintenance for this code. This means that there have been no updates or revisions to the code since its addition. The code has a coverage code of C, indicating that carrier judgment is used to determine coverage. The pricing indicator code is 00, which means that the service is not separately priced by Part B and may be bundled or not covered.

7. Medicare and Insurance Coverage

Medicare and other insurance coverage for HCPCS code G8850 may vary. It is important for healthcare providers to review the specific guidelines and policies of the payer to determine if the service or supply related to this code is payable. The pricing indicator code of 00 indicates that the service is not separately priced by Part B, and the multiple pricing indicator code of 9 indicates that the value is not established or not applicable.

8. Examples

Here are five examples of when HCPCS code G8850 should be billed:

1. A patient with a diagnosis of sleep apnea does not have a prescription for CPAP therapy, and there is no documented reason for this decision.
2. A provider evaluates a patient with suspected sleep-disordered breathing but determines that positive airway pressure therapy is not necessary, and there is no documented reason for this decision.
3. A patient previously prescribed with CPAP therapy stops using the device without a documented reason for discontinuation.
4. A provider assesses a patient with a history of sleep apnea and determines that positive airway pressure therapy is not appropriate, and there is no documented reason for this decision.
5. A patient with symptoms of sleep-disordered breathing is evaluated, and the provider determines that positive airway pressure therapy is not necessary, without a documented reason for this decision.