How To Use HCPCS Code G9666

HCPCS code G9666 describes the patient’s highest fasting or direct LDL-C laboratory test result in the measurement period or two years prior to the beginning of the measurement period, which falls within the range of 70-189 mg/dL. This code is used to identify and document the specific LDL-C level for billing and reimbursement purposes.

1. What is HCPCS G9666?

HCPCS code G9666 is a specific code used in medical coding to indicate the patient’s highest fasting or direct LDL-C laboratory test result within a specific measurement period. It is important to note that this code is only applicable when the LDL-C level falls within the range of 70-189 mg/dL.

2. Official Description

The official description of HCPCS code G9666 is as follows: “Patient’s highest fasting or direct LDL-C laboratory test result in the measurement period or two years prior to the beginning of the measurement period is 70-189 mg/dL.” The short description for this code is “Fas/dir ldl 70-189mg/dl mst.”

3. Procedure

  1. The healthcare provider should first determine the patient’s highest fasting or direct LDL-C laboratory test result within the specified measurement period or two years prior to the beginning of the measurement period.
  2. If the LDL-C level falls within the range of 70-189 mg/dL, the provider should assign HCPCS code G9666 to accurately document and report this information.
  3. It is essential to ensure that the LDL-C level is properly documented in the patient’s medical records to support the use of this code.

4. When to use HCPCS code G9666

HCPCS code G9666 should be used when the patient’s highest fasting or direct LDL-C laboratory test result falls within the range of 70-189 mg/dL. It is important to note that this code is not applicable for LDL-C levels outside of this specified range.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9666, healthcare providers should ensure that the patient’s medical records clearly document the highest fasting or direct LDL-C laboratory test result within the specified measurement period. This documentation should include the date of the test, the specific LDL-C level, and any relevant supporting information.

6. Historical Information and Code Maintenance

HCPCS code G9666 was added to the Healthcare Common Procedure Coding System on January 1, 2016. It has a termination date of December 31, 2021. As of January 1, 2022, this code is no longer maintained and should not be used for billing or reporting purposes.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may have specific coverage policies for HCPCS code G9666. It is important to review the individual payer’s guidelines to determine if this code is eligible for reimbursement. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value is not established or the code is not priced separately by Part B.

8. Examples

Here are some examples of when HCPCS code G9666 should be billed:

  1. Example 1: A patient undergoes a fasting LDL-C laboratory test, and the highest recorded result within the measurement period is 150 mg/dL. HCPCS code G9666 should be assigned to accurately document this LDL-C level.
  2. Example 2: A patient’s direct LDL-C laboratory test result from two years prior to the measurement period is 80 mg/dL. As this falls within the specified range, HCPCS code G9666 should be used to report this information.
  3. Example 3: A patient’s highest fasting LDL-C laboratory test result within the measurement period is 200 mg/dL. Since this LDL-C level exceeds the specified range, HCPCS code G9666 should not be used.
  4. Example 4: A patient’s direct LDL-C laboratory test result from three years prior to the measurement period is 60 mg/dL. As this falls outside the specified measurement period, HCPCS code G9666 should not be assigned.
  5. Example 5: A patient’s highest fasting LDL-C laboratory test result within the measurement period is 100 mg/dL. This falls within the specified range, and HCPCS code G9666 should be used to accurately document this information.

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