HCPCS Service Codes - Medical care

HCPCS Codes for Medical care

• G8841

  Sleep apnea symptoms not assessed, reason not given

• G8842

  Apnea hypopnea index (ahi), respiratory disturbance index (rdi) or respiratory event index (rei) documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea

• G8843

  Documentation of reason(s) for not measuring an apnea hypopnea index (ahi), a respiratory disturbance index (rdi), or a respiratory event index (rei) within 2 months after initial evaluation for suspected obstructive sleep apnea (e.g., medical, neurological, or psychiatric disease that prohibits successful completion of a sleep study, patients for whom a sleep study would present a bigger risk than benefit or would pose an undue burden, dementia, patients previously diagnosed with osa and severity assessed by another provider, patients who decline ahi/rdi/rei measurement, patients who had a financial reason for not completing testing, test was ordered but not completed, patients decline because their insurance (payer) does not cover the expense)

• G8844

  Apnea hypopnea index (ahi), respiratory disturbance index (rdi), or respiratory event index (rei) not documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea, reason not given

• G8845

  Positive airway pressure therapy prescribed

• G8846

  Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater)

• G8848

  Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15)

• G8849

  Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage)

• G8850

  Positive airway pressure therapy not prescribed, reason not given

• G8851

  Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented)

• G8852

  Positive airway pressure therapy was prescribed

• G8853

  Positive airway pressure therapy not prescribed

• G8854

  Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy)

• G8855

  Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given

• G8856

  Referral to a physician for an otologic evaluation performed

• G8857

  Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)

• G8858

  Referral to a physician for an otologic evaluation not performed, reason not given

• G8859

  Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days

• G8860

  Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days

• G8861

  Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed

• G8862

  Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days

• G8863

  Patients not assessed for risk of bone loss, reason not given

• G8864

  Pneumococcal vaccine administered or previously received

• G8865

  Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)

• G8866

  Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal)

• G8867

  Pneumococcal vaccine not administered or previously received, reason not given

• G8868

  Patients receiving a first course of anti-tnf therapy

• G8869

  Patient has documented immunity to hepatitis b and initiating anti-tnf therapy

• G8870

  Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy

• G8871

  Patient not receiving a first course of anti-tnf therapy

• G8872

  Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion

• G8873

  Patients with needle localization specimens which are not amenable to intraoperative imaging such as mri needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site)

• G8874

  Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion

• G8875

  Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method

• G8876

  Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician)

• G8877

  Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given

• G8878

  Sentinel lymph node biopsy procedure performed

• G8879

  Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer

• G8880

  Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change)

• G8881

  Stage of breast cancer is greater than t1n0m0 or t2n0m0

• G8882

  Sentinel lymph node biopsy procedure not performed, reason not given

• G8883

  Biopsy results reviewed, communicated, tracked and documented

• G8884

  Clinician documented reason that patient's biopsy results were not reviewed

• G8885

  Biopsy results not reviewed, communicated, tracked or documented

• G8886

  Most recent blood pressure under control

• G8887

  Documentation of medical reason(s) for most recent blood pressure not being under control (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)

• G8888

  Most recent blood pressure not under control, results documented and reviewed

• G8889

  No documentation of blood pressure measurement, reason not given

• G8890

  Most recent ldl-c under control, results documented and reviewed

• G8891

  Documentation of medical reason(s) for most recent ldl-c not under control (e.g., patients with palliative goals for whom treatment of hypertension with standard treatment goals is not clinically appropriate)