Summary & Overview
HCPCS G8497: CABG Quality Measures Completed
HCPCS Level II code G8497 documents that all applicable quality measures for the coronary artery bypass graft (CABG) measures group have been completed for a patient. Nationally, quality-reporting codes such as G8497 support standardized tracking of perioperative processes and outcomes for CABG, enabling payers and providers to monitor adherence to clinical quality measures and reporting programs. This matters across hospitals and cardiac surgery programs because complete quality action reporting is often tied to value-based payment programs, public reporting, and internal quality improvement efforts. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what the code represents clinically and administratively, which settings typically use it, and the types of benchmarks and policy contexts that make its use relevant. The publication also summarizes payer coverage considerations, common reporting pathways, and implications for compliance and quality documentation. Data not available in the input is noted where specific payer policies or modifiers were not provided.
Billing Code Overview
HCPCS Level II code G8497 indicates that all quality actions for the applicable measures in the coronary artery bypass graft (CABG) measures group have been performed for this patient. This code documents completion of the full set of quality measures tied to CABG care.
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Service Type: Quality reporting / outcomes documentation for CABG care
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Typical Site of Service: Inpatient hospital or cardiac surgical facility where CABG procedures and associated quality assessments occur
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult admitted for elective or urgent coronary artery bypass grafting (CABG) due to multivessel coronary artery disease with symptoms such as refractory angina or acute coronary syndrome not amenable to percutaneous coronary intervention. The clinical workflow begins with preoperative evaluation including history, physical exam, medication reconciliation, cardiac catheterization results, and optimization of comorbidities (e.g., diabetes, hypertension, heart failure). The surgical team documents the CABG procedure details, graft types (saphenous vein, internal mammary artery), number of grafts, and intraoperative events.
Postoperatively, the multidisciplinary team completes discharge planning, prescriptions (antiplatelet therapy, statin, beta blocker), smoking cessation counseling, cardiac rehabilitation referral, and documentation of wound care instructions. Quality measure abstraction for the CABG measures group is performed by clinical documentation specialists or quality staff to confirm that all required quality actions were performed and documented for the patient, which supports reporting under billing code G8497.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when an unrelated E/M is performed and documented on the same day as CABG-related services. |