How To Use HCPCS Code G8974

HCPCS code G8974 describes a specific medical procedure related to the measurement of hemoglobin levels. This code is used when the hemoglobin level is not documented, and the reason for not documenting it is not given. In this article, we will explore the details of HCPCS code G8974, 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 G8974?

HCPCS code G8974 is a specific code used to identify the measurement of hemoglobin levels when the documentation is missing, and the reason for not documenting it is not provided. It helps in accurately reporting and tracking the absence of hemoglobin level documentation in medical records.

2. Official Description

The official description of HCPCS code G8974 is “Hemoglobin level measurement not documented, reason not given.” This description precisely defines the purpose and scope of this code.

3. Procedure

1. The healthcare provider should review the patient’s medical records and determine if the hemoglobin level has been documented.
2. If the hemoglobin level is not documented, the provider should investigate the reason for the missing documentation.
3. If the reason for not documenting the hemoglobin level is not given, HCPCS code G8974 should be assigned.
4. The provider should ensure accurate and complete documentation of the patient’s medical condition and any relevant factors that may affect the hemoglobin level.
5. Proper documentation should include the date and time of the measurement, the method used for measurement, and any other pertinent details.

4. When to use HCPCS code G8974

HCPCS code G8974 should be used in situations where the hemoglobin level is not documented in the medical records, and the reason for not documenting it is not provided. It is essential to accurately report the absence of hemoglobin level documentation to ensure comprehensive and transparent medical coding.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8974, healthcare providers need to ensure proper documentation of the absence of hemoglobin level measurement and the reason for not documenting it. This documentation should be included in the patient’s medical records and support the medical necessity of the procedure. It is crucial to follow the specific billing guidelines provided by the payer to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G8974 was added to the Healthcare Common Procedure Coding System on January 01, 2013. It has a coverage code of C, indicating that carrier judgment is used to determine coverage. The code has no maintenance actions, as indicated by the action code N. HCPCS code G8974 was terminated on December 31, 2020, and is no longer in use.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G8974 may vary. It is essential to check with the specific payer to determine if this code is payable. The pricing indicator code for this code is 00, indicating that the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value is not established. It is crucial to understand the pricing and coverage policies of Medicare and other insurers to ensure accurate billing and reimbursement.

8. Examples

Here are five examples of scenarios where HCPCS code G8974 should be billed:

1. A patient’s medical record does not include documentation of the hemoglobin level, and no reason for not documenting it is provided.
2. During a routine check-up, the healthcare provider forgets to document the hemoglobin level, and no reason for the omission is given.
3. A patient’s medical record indicates that the hemoglobin level measurement was not performed, and no reason is provided for not conducting the test.
4. Due to technical issues, the hemoglobin level measurement could not be documented, and no reason for the technical issue is given.
5. A patient refuses to have their hemoglobin level measured, and no reason for the refusal is provided in the medical record.