How To Use HCPCS Code G9277

HCPCS code G9277 describes the documentation required to indicate that a patient is on daily aspirin or anti-platelet medication, or has a valid contraindication or exception to taking these medications. This code is used to ensure accurate billing and reimbursement for healthcare services related to the patient’s aspirin or anti-platelet therapy.

1. What is HCPCS G9277?

HCPCS code G9277 is a specific code used in medical coding to identify and document the patient’s use of daily aspirin or anti-platelet medication, or the presence of a valid contraindication or exception to taking these medications. It is important for medical coders to correctly assign this code to ensure accurate billing and reimbursement for the related healthcare services.

2. Official Description

The official description of HCPCS code G9277 is as follows: “Documentation that the patient is on daily aspirin or anti-platelet or has documentation of a valid contraindication or exception to aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use, allergy to aspirin or anti-platelets, history of gastrointestinal bleed and bleeding disorder; additionally, the following exceptions documented by the physician as a reason for not taking daily aspirin or anti-platelet are acceptable (use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension defined as >180 systolic or >110 diastolic or gastroesophageal reflux).” The short description for this code is “Doc daily aspirin or contra.”

3. Procedure

1. The healthcare provider must document that the patient is on daily aspirin or anti-platelet medication.
2. If the patient has a valid contraindication or exception to taking daily aspirin or anti-platelet medication, the healthcare provider must document the specific reason for the contraindication or exception.
3. The contraindications or exceptions may include the use of anti-coagulant medication, allergy to aspirin or anti-platelets, history of gastrointestinal bleed or bleeding disorder.
4. Additionally, the following exceptions documented by the physician as a reason for not taking daily aspirin or anti-platelet medication are acceptable: use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension defined as >180 systolic or >110 diastolic, or gastroesophageal reflux.

4. When to use HCPCS code G9277

HCPCS code G9277 should be used when documenting the patient’s use of daily aspirin or anti-platelet medication, or when there is a valid contraindication or exception to taking these medications. It is important to accurately document and code this information to ensure appropriate billing and reimbursement for related healthcare services.

5. Billing Guidelines and Documentation Requirements

Healthcare providers must ensure proper documentation to support the use of HCPCS code G9277. The documentation should include evidence that the patient is on daily aspirin or anti-platelet medication, or documentation of a valid contraindication or exception to taking these medications. This may include medical records, physician notes, or other relevant documentation.

6. Historical Information and Code Maintenance

HCPCS code G9277 was added to the Healthcare Common Procedure Coding System on January 01, 2014. It has an effective date of January 01, 2016. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G9277 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This code is typically bundled or not covered as a separate service. The multiple pricing indicator code is 9, which means that it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9277 should be billed:

1. A patient is documented to be on daily aspirin therapy for cardiovascular disease prevention.
2. A patient has a documented contraindication to taking aspirin due to a severe allergy.
3. A patient has a history of gastrointestinal bleeding and is advised against taking anti-platelet medication.
4. A patient is on an anti-coagulant medication and is not prescribed daily aspirin or anti-platelet therapy.
5. A patient has uncontrolled hypertension with systolic blood pressure consistently above 180 mmHg and is not recommended to take daily aspirin or anti-platelet medication.