How To Use HCPCS Code G8951

HCPCS code G8951 describes a pre-hypertensive or hypertensive blood pressure reading that is documented, but there is no indication of follow-up or eligibility for the patient. This code was terminated on December 31, 2015, and falls under the category of “Pre-htn/htn doc, no pt f/u.” It is important for medical coders to understand the specific meaning and usage of this code in order to accurately assign it for billing purposes.

1. What is HCPCS G8951?

HCPCS code G8951 is used to identify a pre-hypertensive or hypertensive blood pressure reading that is documented, but there is no indication of follow-up or eligibility for the patient. This code is specific to cases where the healthcare provider has recorded the patient’s blood pressure, but there is no documentation of any further action or plan for monitoring or managing the patient’s blood pressure.

2. Official Description

The official description of HCPCS code G8951 is “Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible.” The short description for this code is “Pre-htn/htn doc, no pt f/u.”

3. Procedure

1. The healthcare provider measures the patient’s blood pressure using a sphygmomanometer or an automated blood pressure monitor.
2. The provider records the systolic and diastolic blood pressure readings in the patient’s medical record.
3. If the blood pressure reading indicates pre-hypertension or hypertension, the provider should document this information.
4. However, it is important to note that there should be no indication of follow-up or eligibility for the patient in the documentation.

4. When to use HCPCS code G8951

HCPCS code G8951 should be used when a pre-hypertensive or hypertensive blood pressure reading is documented, but there is no indication of follow-up or eligibility for the patient. It is important to accurately assign this code when the documentation meets the specific criteria outlined in the official description.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8951, healthcare providers need to ensure that the documentation clearly indicates a pre-hypertensive or hypertensive blood pressure reading, the absence of any follow-up plan, and the patient’s ineligibility for further monitoring or management. It is crucial to provide accurate and detailed documentation to support the use of this code for billing purposes.

6. Historical Information and Code Maintenance

HCPCS code G8951 was added to the Healthcare Common Procedure Coding System on January 01, 2013. It was terminated on December 31, 2015. The termination of this code means that it is no longer valid for billing purposes. It is important for medical coders to stay updated on any changes or revisions to HCPCS codes to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

HCPCS code G8951 falls under the coverage code C, which indicates that coverage is determined by carrier judgment. This means that Medicare or other insurance carriers will make a determination on whether to cover the service or supply based on their own policies and guidelines. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. It is important to check with Medicare or the specific insurance carrier for their coverage and pricing policies regarding HCPCS code G8951.

8. Examples

Here are five examples of scenarios where HCPCS code G8951 may be used:

1. A patient visits their primary care physician for a routine check-up. During the visit, the physician measures the patient’s blood pressure and records a pre-hypertensive reading. However, there is no indication of any follow-up plan or eligibility for further monitoring or management.
2. A patient presents to the emergency room with high blood pressure. The emergency room physician documents the hypertensive blood pressure reading, but there is no indication of any follow-up plan or eligibility for further monitoring or management.
3. A patient visits a cardiologist for a consultation regarding their high blood pressure. The cardiologist records the hypertensive blood pressure reading, but there is no indication of any follow-up plan or eligibility for further monitoring or management.
4. A patient participates in a research study on hypertension. As part of the study protocol, the patient’s blood pressure is measured and documented, but there is no indication of any follow-up plan or eligibility for further monitoring or management.
5. A patient undergoes a pre-operative assessment before a surgical procedure. The healthcare provider measures the patient’s blood pressure and records a pre-hypertensive reading. However, there is no indication of any follow-up plan or eligibility for further monitoring or management.