How To Use HCPCS Code G8972

HCPCS code G8972 describes a specific medical condition or risk factors related to thromboembolism. This code is used to identify patients who have one or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism. In this article, we will explore the details of HCPCS code G8972, 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 G8972?

HCPCS code G8972 is used to identify patients who have one or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism. Thromboembolism refers to the formation of a blood clot that can block blood flow in a blood vessel, leading to serious complications. This code helps healthcare providers to accurately document and track patients with these specific risk factors.

2. Official Description

The official description of HCPCS code G8972 is “One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism.” The short description for this code is “1>=risk or>= mod risk for te.”

3. Procedure

1. HCPCS code G8972 does not refer to a specific procedure or treatment. Instead, it identifies patients who have specific risk factors for thromboembolism.
2. Healthcare providers should review the patient’s medical history, perform a thorough physical examination, and assess the presence of high or moderate risk factors for thromboembolism.
3. If the patient meets the criteria for one or more high risk factors or more than one moderate risk factor, HCPCS code G8972 should be assigned to accurately document the patient’s condition.

4. When to use HCPCS code G8972

HCPCS code G8972 should be used when a patient has one or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism. The specific risk factors may vary depending on the patient’s medical history, underlying conditions, and other relevant factors. Healthcare providers should refer to the official description of the code and any additional guidelines provided by relevant coding authorities to determine the appropriate use of this code.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies related to HCPCS code G8972, healthcare providers should ensure proper documentation to support the medical necessity of the code. This may include:

• Medical records documenting the presence of one or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism.
• Documentation of the patient’s medical history, including any relevant diagnoses or conditions that contribute to the risk factors.
• Any additional documentation required by payers or coding guidelines to support the use of this code.

6. Historical Information and Code Maintenance

HCPCS code G8972 was added to the Healthcare Common Procedure Coding System on January 01, 2013. It has an effective date of January 01, 2018. This code has a pricing indicator code of 00, which means it is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G8972 may vary depending on the payer. Medicare coverage for this code is determined by carrier judgment (coverage code C). Healthcare providers should consult with the specific payer or insurance company to determine the coverage and reimbursement policies for this code.

8. Examples

Here are five examples of when HCPCS code G8972 should be billed:

1. A patient with a history of deep vein thrombosis and a recent surgery.
2. A patient with atrial fibrillation and a history of stroke.
3. A patient with multiple risk factors for thromboembolism, including obesity, smoking, and a sedentary lifestyle.
4. A patient with a known genetic mutation that increases the risk of blood clots.
5. A patient with a recent hospitalization and immobility due to a medical condition.