How To Use HCPCS Code G8938

HCPCS code G8938 describes a specific scenario where the patient’s Body Mass Index (BMI) is documented as being outside of normal parameters, but there is no follow-up plan documented, and the patient is deemed ineligible for further intervention or treatment. This code is used to indicate that the healthcare provider has identified an abnormal BMI, but no further action or treatment plan has been documented.

1. What is HCPCS G8938?

HCPCS code G8938 is a specific code used in medical coding to identify cases where the patient’s BMI is outside of normal parameters, but no follow-up plan is documented, and the patient is deemed ineligible for further intervention or treatment. This code provides a standardized way to communicate this specific scenario in medical billing and coding.

2. Official Description

The official description of HCPCS code G8938 is “Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible.” The short description for this code is “Bmi doc onl fup nt doc.”

3. Procedure

1. The healthcare provider identifies that the patient’s BMI is outside of normal parameters through appropriate measurements and calculations.
2. The provider documents the abnormal BMI in the patient’s medical record.
3. No follow-up plan or further intervention is documented for the patient.
4. The provider determines that the patient is not eligible for any additional treatment or intervention based on the specific circumstances.

4. When to use HCPCS code G8938

HCPCS code G8938 should be used when the healthcare provider has documented that the patient’s BMI is outside of normal parameters, but no follow-up plan is documented, and the patient is deemed ineligible for further intervention or treatment. It is important to accurately capture this specific scenario in medical coding to ensure proper communication and billing.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8938, healthcare providers need to ensure that the patient’s medical record clearly documents the following:

• The patient’s BMI measurement and calculation.
• The provider’s assessment that the BMI is outside of normal parameters.
• The absence of a documented follow-up plan.
• The provider’s determination that the patient is not eligible for further intervention or treatment.

Accurate and detailed documentation is crucial for proper billing and coding of HCPCS code G8938.

6. Historical Information and Code Maintenance

HCPCS code G8938 was added to the Healthcare Common Procedure Coding System on January 01, 2013. It has a termination date of December 31, 2021. No maintenance actions have been taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage for HCPCS code G8938 is determined by the carrier’s judgment. Medicare and other insurance providers may have specific guidelines and policies regarding the reimbursement and coverage of this code. It is important to consult the respective payer’s guidelines to determine the coverage and reimbursement for this specific scenario.

8. Examples

Here are five examples of scenarios where HCPCS code G8938 would be used:

1. A patient’s BMI is calculated to be significantly above the normal range, but no follow-up plan is documented, and the provider determines that the patient is not eligible for further intervention or treatment.
2. A patient’s BMI falls below the normal range, but no follow-up plan is documented, and the provider determines that the patient is not eligible for further intervention or treatment.
3. A patient’s BMI is documented as being outside of normal parameters, but no follow-up plan is documented, and the provider determines that the patient’s condition does not require any further intervention or treatment.
4. A patient’s BMI is calculated to be significantly above the normal range, but no follow-up plan is documented, and the provider determines that the patient’s underlying medical condition makes them ineligible for further intervention or treatment.
5. A patient’s BMI falls below the normal range, but no follow-up plan is documented, and the provider determines that the patient’s overall health status does not warrant any further intervention or treatment.