How To Use HCPCS Code G9368

HCPCS code G9368 describes the requirement of at least two orders for high-risk medications from the same drug class not being ordered. This code is used to indicate that a healthcare provider has not ordered the necessary medications for a patient, which could potentially put the patient at risk.

1. What is HCPCS G9368?

HCPCS code G9368 is a specific code used in medical coding to identify the situation where a healthcare provider fails to order at least two high-risk medications from the same drug class. This code is important for tracking and monitoring medication ordering practices and ensuring patient safety.

2. Official Description

The official description of HCPCS code G9368 is “At least two orders for high-risk medications from the same drug class not ordered.” The short description for this code is “>= 2 same hi-rsk med not ord.”

3. Procedure

1. Identify the high-risk medications that are required for the patient.
2. Ensure that at least two medications from the same drug class are necessary for the patient’s condition.
3. Verify that the healthcare provider has not ordered these medications.
4. Assign HCPCS code G9368 to indicate the failure to order the required medications.

4. When to use HCPCS code G9368

HCPCS code G9368 should be used when a healthcare provider has not ordered at least two high-risk medications from the same drug class that are necessary for the patient’s condition. This code is used to indicate a failure in medication ordering and highlights potential risks to patient safety.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9368, healthcare providers need to document the specific high-risk medications that were not ordered and the reasons for not ordering them. This documentation is important for justifying the use of this code and ensuring accurate billing.

6. Historical Information and Code Maintenance

HCPCS code G9368 was added to the Healthcare Common Procedure Coding System on January 01, 2015. As of January 01, 2022, 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

The coverage for HCPCS code G9368 is determined by the carrier judgment, as indicated by the coverage code C. This means that the decision to cover this code is made by the insurance carrier based on their policies and guidelines. 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 is either not covered, bundled, or used by Part A only.

8. Examples

Here are five examples of when HCPCS code G9368 should be billed:

1. A patient with a history of heart disease and high blood pressure requires at least two different medications from the ACE inhibitor drug class. However, the healthcare provider fails to order any medications from this class.
2. A patient with diabetes and kidney disease needs at least two medications from the SGLT2 inhibitor drug class. Unfortunately, the healthcare provider does not order any medications from this class.
3. A patient with asthma and chronic obstructive pulmonary disease (COPD) requires at least two medications from the long-acting beta-agonist (LABA) drug class. However, the healthcare provider does not order any medications from this class.
4. A patient with epilepsy and seizures needs at least two medications from the antiepileptic drug class. Unfortunately, the healthcare provider fails to order any medications from this class.
5. A patient with rheumatoid arthritis requires at least two medications from the disease-modifying antirheumatic drug (DMARD) class. However, the healthcare provider does not order any medications from this class.