How To Use HCPCS Code G8973

HCPCS code G8973 describes the most recent hemoglobin (hgb) level being less than 10 g/dl. This code is used to indicate a low hemoglobin level in a patient’s blood, which can be indicative of anemia or other underlying health conditions. In this article, we will explore the details of HCPCS code G8973, 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 G8973?

HCPCS code G8973 is a specific code used in medical coding to identify the most recent hemoglobin level being less than 10 g/dl. It is important to note that this code is only applicable when the hemoglobin level falls below this specific threshold. Medical coders use this code to accurately document and communicate the patient’s hemoglobin level to healthcare providers, insurance companies, and other relevant parties.

2. Official Description

The official description of HCPCS code G8973 is “Most recent hemoglobin (hgb) level < 10 g/dl." This description clearly states that this code is used to indicate the most recent hemoglobin level being below 10 g/dl. The short description of this code is "Mst rcnt hbb < 10g/dl."

3. Procedure

1. The procedure for using HCPCS code G8973 involves obtaining the most recent hemoglobin level of the patient.
2. If the hemoglobin level is found to be less than 10 g/dl, the medical coder assigns the code G8973 to accurately represent this finding.
3. The code is then included in the patient’s medical records, claims, and other relevant documents for proper documentation and billing purposes.

4. When to use HCPCS code G8973

HCPCS code G8973 should be used when the most recent hemoglobin level of a patient is measured to be less than 10 g/dl. This code is specifically designed to capture and communicate this specific hemoglobin level, which can be indicative of anemia or other related conditions. It is important to use this code accurately and only when the hemoglobin level falls below the specified threshold.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G8973, healthcare providers need to ensure proper documentation and billing for the service or supply. The following guidelines and requirements should be followed:

• Include the code G8973 in the appropriate section of the medical claim or billing document.
• Ensure that the patient’s most recent hemoglobin level is clearly documented in the medical records.
• Provide any additional relevant information or context regarding the hemoglobin level, such as the date of the measurement or any associated symptoms or conditions.
• Follow the specific billing guidelines and requirements of the insurance company or payer to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G8973 was added to the Healthcare Common Procedure Coding System on January 01, 2013. It has an effective date of January 01, 2021. This code has a coverage code of C, which indicates that carrier judgment is used to determine coverage. The action code for this code is N, indicating that no maintenance actions have been taken for this code. The pricing indicator code is 00, which means that the service 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.

7. Medicare and Insurance Coverage

HCPCS code G8973 may be covered by Medicare and other insurance providers, subject to their specific coverage policies and guidelines. The carrier judgment is used to determine the coverage for this code. It is important for healthcare providers to verify the coverage and reimbursement policies of the respective insurance companies or payers to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G8973 should be billed:

1. A patient with a recent diagnosis of anemia has a hemoglobin level of 9 g/dl.
2. A patient undergoing chemotherapy treatment experiences a decrease in hemoglobin level to 8 g/dl.
3. An elderly patient with chronic kidney disease has a hemoglobin level of 7 g/dl.
4. A pregnant patient with iron deficiency anemia has a hemoglobin level of 6 g/dl.
5. A patient with gastrointestinal bleeding presents with a hemoglobin level of 9.5 g/dl.