Question 1

What is HCPCS code G8697?

Accepted Answer

HCPCS code G8697 is "Antithromb no presc doc reas". Antithrombotic therapy not prescribed for documented reasons (e.g., patient had stroke during hospital stay, patient expired during inpatient stay, other medical reason(s)); (e.g., patient left against medical advice, other patient reason(s))

Question 2

What category is G8697 in?

Accepted Answer

G8697 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G8697?

Accepted Answer

Use G8697 when billing for antithromb no presc doc reas. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G8697 covered by Medicare?

Accepted Answer

Coverage for G8697 (Antithromb no presc doc reas) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G8697?

Accepted Answer

Documentation for G8697 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).