G8580 HCPCS: Antiplatelet Contraindication Reimbursement | OpenPayer

Summary & Overview

HCPCS G8580: Antiplatelet Medication Contraindicated

HCPCS Level II code G8580 documents that a patient has a contraindication to antiplatelet medication. Nationally, clear documentation of medication contraindications is critical for care coordination, patient safety, and accurate claims processing. Use of G8580 signals that standard antiplatelet therapy is not appropriate for a given patient due to clinical risk factors.

This analysis covers common national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the code, common sites of service where the code is applied, and the implications for claims documentation. The publication outlines typical billing considerations, coding placement on the service line, and how the code fits into medication reconciliation workflows. Where specific payer policy details are required, the summary indicates whether data was available; if not, it states that those specifics are not included.

By focusing on clinical rationale and documentation needs, the article helps billing, clinical, and compliance teams understand when G8580 is appropriate to report, what documentation to maintain, and which national payers are likely to encounter the code on claims.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG8580HCPCS Level IIantiplateletmedication-contraindicationmedication-reconciliationclinical-documentationoutpatientinpatientbilling

Billing Code Overview

HCPCS Level II code G8580 indicates antiplatelet medication contraindicated. This code is used to document that a patient has a clinical contraindication to antiplatelet therapy, reflecting a safety or medical-limiting condition that prevents use of antiplatelet agents.

Service type: Medication contraindication documentation / Clinical assessment

Typical site of service: Outpatient clinical settings or inpatient hospital encounters where medication reconciliation and contraindications are documented

Clinical & Coding Specifications

Clinical Context

A patient with a history of atrial fibrillation and recent ischemic stroke is evaluated in a cardiology clinic to determine suitability for antiplatelet therapy. During medication reconciliation the clinician documents that antiplatelet therapy is contraindicated due to recent major gastrointestinal bleeding and current anticoagulation with a direct oral anticoagulant. The workflow includes review of prior hospital records, reconciliation of active medications, risk–benefit discussion documented in the chart, and placement of the billing code G8580 on the outpatient encounter record to indicate that antiplatelet medication is contraindicated for this patient.

The typical site of service is an outpatient clinic (cardiology, neurology, or primary care) or transition-of-care visit after hospital discharge where medication decisions are finalized. Common clinical activities during the visit include medication history review, assessment of bleeding risk, coordination with gastroenterology and hematology if needed, and clear documentation of the specific contraindication and supporting clinical data (e.g., recent endoscopy report, INR trends, or imaging).

Coding Specifications

Modifier	Description	When to Use
`24`	Unrelated Evaluation and Management (E/M) service by the same physician during a postoperative period	Use when an unrelated E/M visit occurs while patient is in a global period and is reported as part of that visit documentation

HCPCS G9100: Gastric Cancer Disease-Status Post R0 Resection

HCPCS-G6039-ACETAMINOPHEN-MEDICATION-SUPPLY

HCPCS G6039: Acetaminophen

HCPCS-G2199-PATIENT-NOT-SCREENED-UNHEALTHY-ALCOHOL-USE

HCPCS G2199: Patient Not Screened for Unhealthy Alcohol Use

HCPCS-G8990-THERAPY-PRIMARY-FUNCTIONAL-LIMITATION-STATUS

HCPCS G8990: Other Therapy Primary Functional Limitation, Current Status

HCPCS-G9073-INVASIVE-BREAST-CANCER-ADRENCARCINOMA-STAGE-IIIA-IIIB-STATUS

HCPCS G9073: Invasive Female Breast Cancer Disease Status, Stage IIIA–IIIB

HCPCS-G2015-COMPREHENSIVE-HOME-CARE-PLAN-OVERSIGHT-60MIN

HCPCS G2015: Comprehensive 60-Min Home Care Plan Oversight

HCPCS-G8770-URINE-PROTEIN-TEST-RESULT-DOCUMENTED-REVIEWED

HCPCS G8770: Urine Protein Test Result Documented and Reviewed

HCPCS-G8965-CARDIAC-STRESS-IMAGING-LOW-CHD-RISK-INITIAL-ASSESSMENT

HCPCS G8965: Cardiac Stress Imaging for Low CHD Risk Patients

HCPCS-G6032-DESIPRAMINE-OUTPATIENT-MEDICATION

HCPCS G6032: Desipramine, Outpatient Medication

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

Showing 1–10 of 1996

G8580

Taxonomy Code	Specialty	Notes
`207RC0000X`	Cardiology	Cardiologists commonly document antiplatelet contraindications in patients with ischemic heart disease or atrial fibrillation when balancing bleeding risk
`2084P0800X`	Neurology	Neurologists assess antiplatelet contraindications after ischemic stroke or transient ischemic attack
`208D00000X`	Internal Medicine	Primary care physicians manage chronic medications and document contraindications during transitions of care
`207L00000X`	Vascular Surgery	Vascular surgeons document contraindications in patients with peripheral arterial disease or post-procedural bleeding concerns
`207K00000X`	Cardiac Electrophysiology	Electrophysiologists document contraindications in patients with device implantation or anticoagulation management needs

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K92.2`	Gastrointestinal hemorrhage, unspecified	Active or recent GI bleeding is a common reason antiplatelet therapy is contraindicated
`I63.9`	Cerebral infarction, unspecified	Recent ischemic stroke may prompt careful consideration and documentation that antiplatelet therapy is contraindicated due to bleeding risk or other factors
`I48.91`	Unspecified atrial fibrillation and atrial flutter	Patients with atrial fibrillation often face decisions about antithrombotic therapy; documentation of antiplatelet contraindication is relevant to management
`D62`	Acute posthemorrhagic anemia	Significant anemia after bleeding can justify withholding antiplatelet therapy and documenting `G8580`
`Z91.19`	Patient's other noncompliance with medical treatment and regimen	When a documented contraindication is due to prior adverse reaction or refusal, this code may be recorded alongside the contraindication
`T81.0XXA`	Hemorrhage and hematoma complicating a procedure, initial encounter	Post-procedural bleeding events can create contraindications to antiplatelet medication and require documentation
`Z98.890`	Other specified postprocedural states	In postprocedural recovery with bleeding risk, antiplatelet therapy may be contraindicated and documented with `G8580`

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common E/M code for outpatient visits where contraindication to antiplatelet therapy is reviewed and documented
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used when the visit includes moderate-complexity decision making about medication contraindication and coordination of care
`99495`	Transitional care management services with moderate medical decision complexity, phone follow-up and office visit within 14 days of discharge	Used when contraindication is addressed during post-discharge medication reconciliation as part of transitional care management
`93000`	Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report	Often performed in cardiac patients when assessing overall risk profile while considering antiplatelet therapy contraindication
`36415`	Collection of venous blood by venipuncture	Used for laboratory testing (e.g., CBC) to evaluate bleeding risk supporting documentation of contraindication

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