HCPCS G8632: Missed or Delayed Prophylactic Parenteral Antibiotics - OpenPayer

Summary & Overview

HCPCS G8632: Missed or Delayed Prophylactic Parenteral Antibiotics

HCPCS Level II code G8632 documents cases where prophylactic parenteral antibiotics were either not ordered or not administered within the guideline window before a surgical incision (one hour generally, two hours for fluoroquinolones and vancomycin), and no rationale was recorded. This code matters nationally as a measure of perioperative infection-prevention processes and documentation quality; timely prophylactic antibiotics are linked to reduced surgical site infections and are frequently reviewed in payer quality programs and hospital reporting. Key payers for this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn what G8632 represents clinically and operationally, why it is used in quality and claims contexts, and what typical service settings look like. The publication provides benchmarks and reporting context where available, summarizes policy implications for national payers, and highlights the clinical timing standards embedded in the code (one-hour window, two-hour exception for certain agents). Where input data is missing, the text notes that specific fields are not available. The aim is to give clinicians, coding professionals, and policy stakeholders a concise reference for how G8632 is applied and interpreted within perioperative quality measurement and billing workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG8632HCPCS Level IIsurgical prophylaxisperioperative carequality measureantibiotic timingsurgical site infectionoperating roomambulatory surgery center

Billing Code Overview

HCPCS Level II code G8632 indicates that prophylactic parenteral antibiotics were not ordered to be given or given within one hour (or within two hours for fluoroquinolones or vancomycin) prior to the surgical incision or start of the procedure, and that no reason was provided for the omission or delay.

Service type: Perioperative antibiotic prophylaxis documentation and quality reporting.

Typical site of service: Operative settings and procedural suites where surgical antibiotic prophylaxis is expected, including hospital operating rooms and ambulatory surgery centers.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 56-year-old male scheduled for an elective open inguinal hernia repair at an ambulatory surgery center arrives day-of-surgery. The surgical team completes the preoperative timeout and the anesthesia induction. Per surgical prophylaxis protocols, a first- or second-generation cephalosporin (such as cefazolin) should be ordered and administered within one hour before incision; alternatives such as vancomycin or a fluoroquinolone require administration within two hours. In this scenario, the perioperative nursing record shows no antibiotic order was placed and no documentation explaining the omission exists. The procedure proceeds to incision without documented prophylactic parenteral antibiotics given within the required timeframe. Postoperative wound surveillance and infection prevention staff review the chart for compliance with Surgical Care Improvement Project (SCIP) measures and identify G8632 as the applicable billing-level II code indicating prophylactic parenteral antibiotics were not ordered or given within the required timeframe and no reason was documented.

Service Type: Surgical prophylaxis compliance reporting for perioperative care
Typical Site of Service: Hospital operating room or ambulatory surgery center
Typical Patient Scenario: Adult elective or urgent surgical patient undergoing a procedure requiring prophylactic parenteral antibiotics where administration was omitted or not documented within the required window and no justification was recorded.

Coding Specifications

HCPCS G9512: Medication Adherence, PDC 0.8 or Greater

HCPCS-G6021-UNLISTED-INTESTINE-PROCEDURE

HCPCS G6021: Unlisted Procedure, Intestine

HCPCS-G8815-STATIN-THERAPY-OMISSION-DOCUMENTED-REASON

HCPCS G8815: Documented Reason for Not Prescribing Statin Therapy

HCPCS-G0047-PEDIATRIC-MINOR-BLUNT-HEAD-TRAUMA-PECARN-NOT-ASSESSED

HCPCS G0047: Pediatric Minor Blunt Head Trauma, PECARN Not Assessed

HCPCS-G2185-CAREGIVER-DEMENTIA-CARE-CERTIFICATION-DOCUMENTATION

HCPCS G2185: Documentation of Caregiver Trained and Certified in Dementia Care

HCPCS-G9431-PATHOLOGY-REPORT-INCOMPLETE-MELANOMA-ELEMENTS

HCPCS G9431: Pathology Report Missing Key Elements for Invasive Tumors

HCPCS-G8721-PATHOLOGY-PT-PN-HISTOLOGIC-GRADE-DOCUMENTATION

HCPCS G8721: Pathology Documentation of PT, PN, and Histologic Grade

HCPCS-G9485-REMOTE-IN-HOME-NEW-PATIENT-EVALUATION-MANAGEMENT-TELEHEALTH

HCPCS G9485: Remote In-Home New Patient Evaluation and Management

HCPCS-G0513-PROLONGED-PREVENTIVE-SERVICE-OFFICE-OUTPATIENT

HCPCS G0513: Prolonged Preventive Service, First 30 Minutes

HCPCS-G8478-BLOOD-PRESSURE-NOT-DOCUMENTED

HCPCS G8478: Blood Pressure Measurement Not Performed or Documented

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207P00000X`	General Surgery	Most common specialty performing operative procedures requiring prophylactic antibiotics
`207L00000X`	Vascular Surgery	Procedures with infection risk where prophylaxis is required
`207K00000X`	Obstetrics & Gynecology	Commonly perform cesarean and gynecologic procedures requiring prophylaxis
`163W00000X`	Anesthesiology	Responsible for perioperative management and timing of antibiotic administration
`207R00000X`	Colon & Rectal Surgery	Procedures with high infection risk where timing of prophylactic antibiotics is critical

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K40.20`	Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent	Representative diagnosis for elective inguinal hernia repair where prophylactic antibiotics are indicated
`K35.80`	Acute appendicitis without perforation or abscess	Represents patients undergoing appendectomy who require timely prophylactic antibiotics
`N83.2`	Torsion of ovary, ovarian pedicle	Gynecologic surgical diagnosis where prophylaxis is part of perioperative care
`K80.20`	Calculus of gallbladder without cholecystitis, without obstruction	Common diagnosis leading to cholecystectomy where antibiotic prophylaxis decisions are part of perioperative protocol
`C50.912`	Malignant neoplasm of unspecified site of right female breast	Represents breast surgery cases (lumpectomy/mastectomy) where perioperative prophylaxis is considered

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`49505`	Repair initial incarcerated or strangulated inguinal hernia; reducible or incarcerated	Typical operative code for open inguinal hernia repair where antibiotic prophylaxis should be given
`44950`	Appendectomy, emergency, for acute appendicitis	Common general surgery procedure requiring timely prophylactic antibiotics prior to incision
`19301`	Mastectomy, partial (partial mastectomy, lumpectomy)	Breast surgery where perioperative prophylactic antibiotics are commonly administered
`58661`	Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)	Gynecologic laparoscopic procedures often require prophylactic antibiotics per guidelines
`47562`	Laparoscopy, surgical; cholecystectomy	Common abdominal procedure where antibiotic prophylaxis is considered based on source and risk
`10060`	Incision and drainage of abscess; simple or single	Minor procedures where antibiotic timing may differ; included as perioperative workflow comparator

`24`	Unrelated evaluation and management service by the same physician during a postoperative period	Use when a separate unrelated E/M is provided during the global period unrelated to the surgery
`25`	Significant, separately identifiable evaluation and management service on the same day as a procedure	Use when an E/M distinct from the surgical procedure is documented on the same day
`59`	Distinct procedural service	Use to indicate a distinct procedure or service not typically reported together; rarely used for prophylaxis documentation
`76`	Repeat procedure or service by same physician	Use when a procedure is repeated subsequent to the original on the same day
`77`	Repeat procedure by another physician	Use when another physician repeats the procedure on same day
`78`	Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period	Use when return to OR occurs related to initial surgery
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during global period
`AA`	Anesthesia services performed personally by anesthesiologist	Use for anesthesia provider reporting; relevant when perioperative antibiotics are assessed during anesthesia care
`QS`	Monitored anesthesia care service performed with intensive monitoring	Use when anesthesia monitoring qualifies as QS; indirectly related to perioperative care workflows
`XE`	Separate encounter, distinct service	Use as a distinct procedural modifier where `59` is insufficient

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