How To Use HCPCS Code G8970

HCPCS code G8970 describes a specific medical condition or risk factor for thromboembolism. This code is used to identify patients who have either no risk factors or one moderate risk factor for thromboembolism. In this article, we will explore the details of HCPCS code G8970, 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 G8970?

HCPCS code G8970 is used to indicate the presence of either no risk factors or one moderate risk factor for thromboembolism. Thromboembolism refers to the formation of a blood clot that can travel through the bloodstream and cause blockages in blood vessels. This code helps healthcare providers identify patients who may be at risk for thromboembolism and allows for appropriate monitoring and treatment.

2. Official Description

The official description of HCPCS code G8970 is “No risk factors or one moderate risk factor for thromboembolism.” The short description is “No rsk fac or 1 mod risk te.” This description accurately reflects the purpose of this code in identifying patients with specific risk factors for thromboembolism.

3. Procedure

1. There is no specific procedure associated with HCPCS code G8970. This code is used primarily for identification and documentation purposes to indicate the presence of specific risk factors for thromboembolism.

4. When to use HCPCS code G8970

HCPCS code G8970 should be used when a patient has either no risk factors or one moderate risk factor for thromboembolism. Risk factors for thromboembolism may include a history of blood clotting disorders, recent surgery, prolonged immobility, obesity, smoking, or the use of certain medications. It is important for healthcare providers to accurately document and code these risk factors to ensure appropriate monitoring and treatment for the patient.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8970, healthcare providers should ensure that the patient’s medical records clearly document the presence of either no risk factors or one moderate risk factor for thromboembolism. This documentation should include relevant medical history, physical examination findings, and any diagnostic tests or procedures performed to assess the patient’s risk. It is important to accurately code and bill for this service to ensure proper reimbursement and compliance with coding guidelines.

6. Historical Information and Code Maintenance

HCPCS code G8970 was added to the Healthcare Common Procedure Coding System on January 01, 2013. 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. This suggests that the code has remained unchanged since its introduction and continues to serve its intended purpose in identifying patients with specific risk factors for thromboembolism.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover services or treatments related to thromboembolism, depending on the specific circumstances and medical necessity. However, the pricing indicator code for HCPCS code G8970 is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare or other insurers. It is important for healthcare providers to verify coverage and reimbursement policies with the respective payers.

8. Examples

Here are five examples of when HCPCS code G8970 should be billed:

1. A patient with no known risk factors for thromboembolism undergoes a surgical procedure. HCPCS code G8970 should be used to indicate the absence of risk factors in the patient’s medical record.
2. A patient with a history of smoking and no other risk factors for thromboembolism is admitted to the hospital for a non-surgical condition. HCPCS code G8970 should be used to indicate the presence of one moderate risk factor in the patient’s medical record.
3. A patient who recently traveled long distances by air and has no other risk factors for thromboembolism presents to the emergency department with leg pain and swelling. HCPCS code G8970 should be used to indicate the absence of risk factors in the patient’s medical record.
4. A patient who is obese and has no other risk factors for thromboembolism undergoes a diagnostic imaging procedure. HCPCS code G8970 should be used to indicate the presence of one moderate risk factor in the patient’s medical record.
5. A patient with a history of blood clotting disorder and no other risk factors for thromboembolism is admitted to the hospital for a surgical procedure. HCPCS code G8970 should be used to indicate the presence of one moderate risk factor in the patient’s medical record.