How To Use HCPCS Code G8952

HCPCS code G8952 describes an elevated or hypertensive blood pressure reading that is documented, but the indicated follow-up is not documented and the reason for the lack of follow-up is not given. This code is used to indicate cases where a patient’s blood pressure is found to be elevated or hypertensive, but there is no documentation of any subsequent follow-up or further action taken to address the issue.

1. What is HCPCS G8952?

HCPCS code G8952 is a specific code used in medical coding to identify cases where a patient’s blood pressure reading is found to be elevated or hypertensive, but there is no documentation of any follow-up or reason for the lack of follow-up. This code is important for accurately capturing and reporting the healthcare services provided to patients with elevated blood pressure readings.

2. Official Description

The official description of HCPCS code G8952 is “Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given.” The short description for this code is “Pre-htn/htn, no f/u, not gvn.”

3. Procedure

1. The healthcare provider measures the patient’s blood pressure using a sphygmomanometer or an automated blood pressure monitor.
2. If the blood pressure reading is found to be elevated or hypertensive, the provider documents the reading in the patient’s medical record.
3. The provider should also document any relevant information regarding the patient’s medical history, symptoms, or other factors that may contribute to the elevated blood pressure.
4. If no follow-up or further action is taken to address the elevated blood pressure, the provider should indicate this in the medical record.
5. If the reason for the lack of follow-up is known, it should also be documented in the medical record.

4. When to use HCPCS code G8952

HCPCS code G8952 should be used in cases where a patient’s blood pressure reading is found to be elevated or hypertensive, but there is no documentation of any follow-up or reason for the lack of follow-up. This code is used to accurately report the lack of follow-up in cases where it is expected or recommended based on the patient’s blood pressure reading.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8952, healthcare providers should ensure that the elevated or hypertensive blood pressure reading is clearly documented in the patient’s medical record. Additionally, the lack of follow-up and the reason for the lack of follow-up, if known, should also be documented. This information is crucial for accurate coding and billing.

6. Historical Information and Code Maintenance

HCPCS code G8952 was added to the Healthcare Common Procedure Coding System on January 01, 2013. As of the effective date of January 01, 2022, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has a pricing indicator code of 00, which means it is not separately priced by Part B and may be bundled or not covered by Medicare.

7. Medicare and Insurance Coverage

HCPCS code G8952 is covered by Medicare, but it is not separately priced by Part B. The pricing indicator code 00 indicates that this service is not separately priced and may be bundled or not covered by Medicare. It is important for healthcare providers to review the specific coverage policies of Medicare and other insurance carriers to determine the reimbursement and coverage for this code.

8. Examples

Here are five examples of when HCPCS code G8952 should be billed:

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 finds it to be elevated. However, there is no documentation of any follow-up or reason for the lack of follow-up.
2. A patient presents to the emergency department with symptoms of high blood pressure. The emergency department physician measures the patient’s blood pressure and confirms it to be hypertensive. However, there is no documentation of any follow-up or reason for the lack of follow-up.
3. A patient undergoes a pre-operative assessment before a surgical procedure. The healthcare provider measures the patient’s blood pressure and finds it to be elevated. However, there is no documentation of any follow-up or reason for the lack of follow-up.
4. A patient visits a cardiologist for a consultation regarding their high blood pressure. The cardiologist measures the patient’s blood pressure and confirms it to be hypertensive. However, there is no documentation of any follow-up or reason for the lack of follow-up.
5. A patient participates in a health screening event where their blood pressure is measured. The healthcare provider identifies an elevated blood pressure reading but does not provide any follow-up or reason for the lack of follow-up.