How To Use HCPCS Code G8866

HCPCS code G8866 describes the documentation of patient reasons for not administering or previously receiving the pneumococcal vaccine. This code is used when a patient refuses to receive the vaccine or has already received it in the past. In this article, we will explore the details of HCPCS code G8866, 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 G8866?

HCPCS code G8866 is used to document patient reasons for not administering or previously receiving the pneumococcal vaccine. It is important for healthcare providers to accurately document the patient’s refusal or previous vaccination history to ensure proper coding and billing.

2. Official Description

The official description of HCPCS code G8866 is “Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal).” The short description is “Doc pt reas no pneumococcal.”

3. Procedure

1. When a patient refuses to receive the pneumococcal vaccine or has already received it in the past, the healthcare provider should document the patient’s reasons for not administering or previously receiving the vaccine.
2. The documentation should include a detailed explanation of the patient’s refusal or previous vaccination history.
3. This information should be accurately recorded in the patient’s medical records for coding and billing purposes.

4. When to use HCPCS code G8866

HCPCS code G8866 should be used when a patient refuses to receive the pneumococcal vaccine or has already received it in the past. It is important to accurately document the patient’s reasons for not administering or previously receiving the vaccine to support the use of this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8866, healthcare providers need to document the patient’s reasons for not administering or previously receiving the pneumococcal vaccine. This documentation should be detailed and clearly explain the patient’s refusal or previous vaccination history.

6. Historical Information and Code Maintenance

HCPCS code G8866 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.

7. Medicare and Insurance Coverage

HCPCS code G8866 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This indicates that the service is bundled or not covered by Part B. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G8866 should be billed:

1. A patient refuses to receive the pneumococcal vaccine due to a severe allergic reaction to a previous dose.
2. A patient has already received the pneumococcal vaccine during a previous hospitalization and does not require another dose.
3. A patient refuses to receive the pneumococcal vaccine due to personal beliefs or religious reasons.
4. A patient has already received the pneumococcal vaccine at a different healthcare facility and provides documentation of the vaccination.
5. A patient refuses to receive the pneumococcal vaccine due to concerns about potential side effects.