How To Use HCPCS Code G9667

HCPCS code G9667 describes the documentation of medical reasons for not currently being a statin therapy user or receiving an order (prescription) for statin therapy. This code is used to indicate specific circumstances where a patient is unable to take statin medication therapy due to various factors such as adverse effects, allergies or intolerances, pregnancy or breastfeeding, palliative care, active liver disease or hepatic insufficiency, end stage renal disease (ESRD), or diabetes with a fasting or direct LDL-C laboratory test result below 70 mg/dl and not taking statin therapy.

1. What is HCPCS G9667?

HCPCS code G9667 is a specific code used in medical coding to identify the documentation of medical reasons for not currently being a statin therapy user or receiving an order for statin therapy. It is important for medical coders to accurately assign this code to ensure proper documentation and billing for patients who meet the specified criteria.

2. Official Description

The official description of HCPCS code G9667 is “Documentation of medical reason(s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (ESRD), and patients with diabetes who have a fasting or direct LDL-C laboratory test result < 70 mg/dl and are not taking statin therapy)." The short description for this code is "Doc med rsn no stat tx/presc."

3. Procedure

  1. When documenting medical reasons for not currently being a statin therapy user or receiving an order for statin therapy, healthcare providers should clearly indicate the specific reason(s) for the patient’s inability to take statin medication therapy.
  2. Providers should document any adverse effects, allergies, or intolerances to statin medication therapy that the patient may have experienced.
  3. If the patient has an active diagnosis of pregnancy or is breastfeeding, this should be clearly documented in the medical record.
  4. For patients receiving palliative care, the provider should document the need for alternative treatment options and the reasons why statin therapy is not appropriate.
  5. If the patient has active liver disease or hepatic insufficiency, the provider should document the condition and its impact on the patient’s ability to take statin medication therapy.
  6. Patients with end stage renal disease (ESRD) should have their inability to take statin therapy documented, along with any specific reasons related to their renal condition.
  7. For patients with diabetes who have a fasting or direct LDL-C laboratory test result below 70 mg/dl and are not taking statin therapy, the provider should document the test result and the decision not to prescribe statin therapy.

4. When to use HCPCS code G9667

HCPCS code G9667 should be used when documenting the medical reasons for not currently being a statin therapy user or receiving an order for statin therapy. It is important to use this code when the patient meets any of the specified criteria outlined in the official description, such as adverse effects, allergies or intolerances, pregnancy or breastfeeding, palliative care, active liver disease or hepatic insufficiency, end stage renal disease (ESRD), or diabetes with a fasting or direct LDL-C laboratory test result below 70 mg/dl and not taking statin therapy.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9667, healthcare providers need to ensure that the medical record clearly documents the medical reasons for not currently being a statin therapy user or receiving an order for statin therapy. This documentation should include specific details about the patient’s condition or circumstances that prevent them from taking statin medication therapy. Providers should also follow the appropriate billing guidelines and submit the claim with the necessary supporting documentation to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9667 was added to the Healthcare Common Procedure Coding System on January 1, 2016. It has an effective date of January 1, 2017. As of December 31, 2016, this code was terminated. No maintenance actions have been taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare coverage for HCPCS code G9667 is determined by carrier judgment, indicated by the coverage code C. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. It is important for healthcare providers to check with Medicare and other insurance providers to determine coverage and reimbursement for this specific code.

8. Examples

Here are five examples of when HCPCS code G9667 should be billed:

  1. A patient with a documented adverse effect to statin medication therapy.
  2. A pregnant patient who is unable to take statin therapy.
  3. A patient with active liver disease or hepatic insufficiency.
  4. A patient with end stage renal disease (ESRD).
  5. A patient with diabetes who has a fasting or direct LDL-C laboratory test result below 70 mg/dl and is not taking statin therapy.

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