How To Use HCPCS Code G8858

HCPCS code G8858 describes a referral to a physician for an otologic evaluation that was not performed, and the reason for not performing the evaluation is not given. This code is used to indicate that a patient was referred to a physician for an evaluation of their ear-related condition, but for some reason, the evaluation did not take place. It is important for medical coders to understand the specific meaning and usage of this code in order to accurately document and bill for the services provided.

1. What is HCPCS G8858?

HCPCS code G8858 is a specific code used in medical coding to identify a referral to a physician for an otologic evaluation that was not performed, and the reason for not performing the evaluation is not given. This code is part of the Healthcare Common Procedure Coding System (HCPCS) and is used to accurately document and bill for healthcare services provided to patients.

2. Official Description

The official description of HCPCS code G8858 is “Referral to a physician for an otologic evaluation not performed, reason not given.” The short description of this code is “Not ref for oto eval.” These descriptions provide a clear understanding of the purpose and usage of this specific code.

3. Procedure

1. When using HCPCS code G8858, the healthcare provider should first determine the need for an otologic evaluation for the patient.
2. If the provider decides that an otologic evaluation is necessary, they should refer the patient to a physician who specializes in otology.
3. However, if the otologic evaluation is not performed for some reason, the provider should document the reason for not performing the evaluation.
4. The provider should then assign HCPCS code G8858 to indicate that a referral for an otologic evaluation was made but not performed, and the reason for not performing the evaluation is not given.

4. When to use HCPCS code G8858

HCPCS code G8858 should be used when a patient is referred to a physician for an otologic evaluation, but for some reason, the evaluation is not performed, and the reason for not performing the evaluation is not given. This code is used to accurately document and communicate the specific circumstances surrounding the referral and non-performance of the otologic evaluation.

5. Billing Guidelines and Documentation Requirements

When billing for services associated with HCPCS code G8858, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the referral for an otologic evaluation
• Documentation of the reason for not performing the evaluation

These documentation requirements are essential for accurate billing and reimbursement for the services provided.

6. Historical Information and Code Maintenance

HCPCS code G8858 was added to the Healthcare Common Procedure Coding System on January 01, 2012. It has an action effective date of January 01, 2013, indicating that this code has been in use since that date. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G8858 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the service is either not covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which means that it is not applicable as HCPCS code G8858 is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G8858 should be billed:

1. A patient is referred to a physician for an otologic evaluation, but the evaluation is not performed due to the patient’s refusal to undergo the procedure.
2. A patient is referred to a physician for an otologic evaluation, but the evaluation is not performed due to the unavailability of the specialist.
3. A patient is referred to a physician for an otologic evaluation, but the evaluation is not performed due to the patient’s non-compliance with the referral.
4. A patient is referred to a physician for an otologic evaluation, but the evaluation is not performed due to the patient’s inability to attend the appointment.
5. A patient is referred to a physician for an otologic evaluation, but the evaluation is not performed due to the patient’s insurance coverage limitations.