How To Use HCPCS Code G9507

HCPCS code G9507 describes the documentation required to indicate that a patient is on a statin medication or has a valid contraindication or exception to statin medications. This code is used to ensure accurate reporting and billing for healthcare services related to statin medications and their contraindications or exceptions.

1. What is HCPCS G9507?

HCPCS code G9507 is a specific code used in medical coding to identify the documentation that a patient is on a statin medication or has a valid contraindication or exception to statin medications. It is important for medical coders to correctly assign this code to ensure accurate reporting and billing for the related healthcare services.

2. Official Description

The official description of HCPCS code G9507 is “Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (HIV protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs).” The short description for this code is “Doc reas on statin or contra.”

3. Procedure

1. The healthcare provider must document that the patient is on a statin medication or has a valid contraindication or exception to statin medications.
2. If the contraindications or exceptions are defined by diagnosis codes, the provider must ensure that the appropriate diagnosis codes are documented.
3. If the contraindications or exceptions are provider-documented, the provider must clearly document the specific contraindication or exception.
4. The documentation should include any supporting documentation, such as lab results or previous medical history, to validate the contraindication or exception.

4. When to use HCPCS code G9507

HCPCS code G9507 should be used when the patient is on a statin medication or has a valid contraindication or exception to statin medications. The specific contraindications or exceptions can be defined by diagnosis codes or provider-documented reasons. It is important to accurately document and code this information to ensure proper reporting and billing for the related healthcare services.

5. Billing Guidelines and Documentation Requirements

When billing for healthcare services related to HCPCS code G9507, healthcare providers must ensure that the documentation supports the patient’s use of a statin medication or the presence of a valid contraindication or exception to statin medications. The documentation should include the specific details of the patient’s condition or situation that justifies the use of this code. It is important to follow the billing guidelines and requirements set forth by the payer to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9507 was added to the Healthcare Common Procedure Coding System on January 01, 2016. As of now, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders to stay updated on any changes or revisions to this code in order to accurately report and bill for the related healthcare services.

7. Medicare and Insurance Coverage

The coverage and reimbursement for HCPCS code G9507 may vary depending on the payer, such as Medicare or other insurance providers. It is important to review the pricing indicator code and multiple pricing indicator code to understand how the service or supply is priced by Medicare or other insurers. Healthcare providers should follow the guidelines and policies set forth by the payer to ensure proper reimbursement for the services related to this code.

8. Examples

Here are five examples of when HCPCS code G9507 should be billed:

1. A patient is on a statin medication for the treatment of high cholesterol, and the healthcare provider documents this information.
2. A patient has a documented contraindication to statin medications due to active liver disease, and the healthcare provider includes the appropriate diagnosis code to support this contraindication.
3. A patient has a provider-documented exception to statin medications due to a drug interaction with HIV protease inhibitors, and the healthcare provider clearly documents this exception.
4. A patient has a provider-documented contraindication to statin medications due to breastfeeding during the measurement period, and the healthcare provider includes the necessary documentation to support this contraindication.
5. A patient has a provider-documented exception to statin medications due to intolerance, with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs.