How To Use HCPCS Code G9745

HCPCS code G9745 describes the documented reason for not screening or recommending a follow-up for high blood pressure. This code is used to indicate that a healthcare provider has a valid reason for not conducting a screening or recommending further evaluation for a patient with high blood pressure. In this article, we will explore the details of HCPCS code G9745, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9745?

HCPCS code G9745 is a specific code used in medical coding to identify the documented reason for not screening or recommending a follow-up for high blood pressure. It is important for medical coders to accurately assign this code to ensure proper documentation and billing for the services provided.

2. Official Description

The official description of HCPCS code G9745 is “Documented reason for not screening or recommending a follow-up for high blood pressure.” The short description is “Doc rsn no hbp scrn or f/u.”

3. Procedure

  1. When a healthcare provider encounters a patient with high blood pressure, they must document the reason for not conducting a screening or recommending a follow-up.
  2. The provider should thoroughly evaluate the patient’s medical history, current condition, and any other relevant factors to determine the appropriate course of action.
  3. If the provider determines that a screening or follow-up is not necessary due to specific patient circumstances, they should document the reason for this decision.
  4. The documentation should be clear, concise, and support the provider’s rationale for not conducting the screening or recommending a follow-up.

4. When to use HCPCS code G9745

HCPCS code G9745 should be used when a healthcare provider has a valid reason for not screening a patient for high blood pressure or recommending a follow-up. This code is used to indicate that the provider has made a deliberate decision based on the patient’s specific circumstances and medical history.

5. Billing Guidelines and Documentation Requirements

When billing for services associated with HCPCS code G9745, healthcare providers must ensure that the documentation supports the reason for not conducting a screening or recommending a follow-up for high blood pressure. The documentation should clearly explain the rationale behind the provider’s decision and provide sufficient information to justify the use of this code.

6. Historical Information and Code Maintenance

HCPCS code G9745 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of January 01, 2018, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code is used to accurately represent the documented reason for not screening or recommending a follow-up for high blood pressure.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may have specific coverage policies for HCPCS code G9745. It is important for healthcare providers to review the pricing indicator code and multiple pricing indicator code associated with this code to understand how it is priced by Medicare or other insurers. The pricing indicator code 00 indicates that the service is not separately priced by Part B, while the multiple pricing indicator code 9 indicates that the value is not established or the code is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9745 should be billed:

  1. A patient with high blood pressure has a documented allergy to the medication typically used for screening.
  2. A patient with high blood pressure is currently undergoing treatment for a more pressing medical condition, and the provider determines that addressing the other condition takes priority over screening for high blood pressure.
  3. A patient with high blood pressure has a documented history of adverse reactions to previous screenings.
  4. A patient with high blood pressure is unable to comply with the necessary preparation requirements for the screening due to physical limitations.
  5. A patient with high blood pressure has a documented terminal illness, and the provider determines that screening or follow-up would not significantly impact the patient’s overall care.

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