How To Use HCPCS Code G9274

HCPCS code G9274 describes blood pressure measurements that fall outside of normal limits. This code is used to identify cases where the systolic value is equal to or greater than 140 and the diastolic value is equal to or greater than 90, or where the systolic value is less than 140 and the diastolic value is equal to 90, or where the systolic value is equal to 140 and the diastolic value is less than 90.

1. What is HCPCS G9274?

HCPCS code G9274 is a specific code used in medical coding to identify blood pressure measurements that are outside of normal limits. It is important for medical coders to accurately assign this code to ensure proper documentation and billing for patients with abnormal blood pressure readings.

2. Official Description

The official description of HCPCS code G9274 is “Bp out of nrml limits.” This short description succinctly conveys that this code is used to indicate blood pressure measurements that are not within the normal range.

3. Procedure

1. When assigning HCPCS code G9274, the medical coder should review the patient’s medical records to determine the blood pressure readings.
2. If the systolic value is equal to or greater than 140 and the diastolic value is equal to or greater than 90, or if the systolic value is less than 140 and the diastolic value is equal to 90, or if the systolic value is equal to 140 and the diastolic value is less than 90, the medical coder should assign HCPCS code G9274.
3. The assigned code should be documented in the patient’s medical record and used for billing purposes.

4. When to use HCPCS code G9274

HCPCS code G9274 should be used when a patient’s blood pressure measurements fall outside of the normal limits. This code is applicable in cases where the systolic value is equal to or greater than 140 and the diastolic value is equal to or greater than 90, or where the systolic value is less than 140 and the diastolic value is equal to 90, or where the systolic value is equal to 140 and the diastolic value is less than 90.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies associated with HCPCS code G9274, healthcare providers should ensure that the patient’s medical record includes documentation of the abnormal blood pressure measurements. This documentation should clearly indicate the specific values for both the systolic and diastolic readings. Additionally, the medical coder should accurately assign HCPCS code G9274 to the appropriate encounter or visit for proper billing.

6. Historical Information and Code Maintenance

HCPCS code G9274 was added to the Healthcare Common Procedure Coding System on January 01, 2014. 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 code remains relevant for identifying cases of blood pressure measurements outside of normal limits.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover services or supplies associated with HCPCS code G9274, depending on the specific circumstances and medical necessity. The pricing indicator code for this code 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. The multiple pricing indicator code is 9, which indicates that the value is not established or not applicable as HCPCS code G9274 is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9274 should be billed:

1. A patient presents with a blood pressure reading of 150/95.
2. A patient’s blood pressure is measured at 135/90.
3. A patient’s blood pressure is recorded as 140/85.
4. A patient’s blood pressure is measured at 130/95.
5. A patient presents with a blood pressure reading of 145/80.