Summary & Overview
HCPCS G9443: Statin Not Prescribed at Discharge
HCPCS Level II code G9443 documents instances where a patient eligible for statin therapy is discharged without a statin prescription. This measure captures a gap in discharge medication management that has implications for secondary prevention of atherosclerotic cardiovascular disease and for quality measurement at the national level. The code is used in administrative and quality reporting contexts to track missed opportunities for guideline-directed therapy.
Key payers included in this national overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical rationale behind tracking statin omission at discharge, the kinds of benchmarks typically reported for medication reconciliation and secondary prevention measures, and relevant policy considerations affecting coding and reporting. The summary covers how G9443 is applied in inpatient discharge workflows, common reporting uses, and where to look for paired quality measures.
This publication provides a concise reference for billing, quality, and compliance teams seeking to understand what G9443 represents, why it matters for population health and quality reporting, and what types of national-level benchmarking and policy guidance influence its use.
Billing Code Overview
HCPCS Level II code G9443 indicates Statin not prescribed at discharge. This code documents that a patient eligible for a statin therapy did not receive a statin prescription at the point of hospital discharge.
-
Service type: Medication reconciliation / discharge medication management
-
Typical site of service: Inpatient hospital discharge or observation discharge
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male admitted to a hospital with an acute myocardial infarction (STEMI) and treated with percutaneous coronary intervention. At discharge, the inpatient team completes medication reconciliation and documents discharge medications. The billing code G9443 is used to indicate that a statin was not prescribed at discharge despite the diagnosis that would typically warrant statin therapy (for example, atherosclerotic cardiovascular disease). The clinical workflow includes: inpatient cardiology and hospitalist teams reviewing active problems and discharge orders; pharmacists performing a final medication reconciliation; documentation in the discharge summary explaining reasons for omission (e.g., documented adverse reaction, patient refusal, or terminal/palliative status); and coding/billing staff assigning G9443 to the claim to reflect the absence of a statin prescription at discharge. Typical site of service is an inpatient acute care hospital or observation stay. Service type is inpatient discharge medication reconciliation/documentation of omission.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
24 | Unrelated evaluation and management service by the same physician during a postoperative period | Use when an unrelated E/M is provided during a post-op period concurrent with documentation of medication omission at discharge |
25 | Significant, separately identifiable E/M service on the same day as a procedure | Use if a separate E/M is provided the day of discharge in addition to discharge documentation |
50 | Bilateral procedure | Not typically applicable to G9443; include only if another service on the claim is bilateral |
52 | Reduced services | Use when a related service was partially reduced or discontinued, documented alongside the statin omission |
57 | Decision for surgery | Use if discharge omission occurs in the context of preoperative decision-making documented as related |
59 | Distinct procedural service | Use when another service on the same day is distinct from the discharge medication documentation |
76 | Repeat procedure or service by same physician | Use if the discharge medication reconciliation was repeated during the same hospitalization |
77 | Repeat procedure by another physician | Use if another clinician repeats the discharge reconciliation |
90 | Reference (outside) laboratory | Use if external testing influenced the decision not to prescribe a statin and is reported on the same claim |
99 | Multiple modifiers (not a CMS standard numeric modifier) | Not applicable; included for completeness only |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RC0000X | Cardiovascular Disease (Cardiology) | Cardiology teams commonly manage lipid therapy decisions for inpatients with coronary disease |
207RH0000X | Interventional Cardiology | Interventionalists involved in PCI and post-procedure discharge planning |
208000000X | Internal Medicine | Hospitalists or internists who complete discharge reconciliation |
183P00000X | Pharmacy | Clinical pharmacists review and document medication omissions at discharge |
207VG0300X | Vascular Medicine | Specialists managing atherosclerotic disease who may influence statin decisions |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I21.3 | ST elevation (STEMI) myocardial infarction of unspecified site | Acute MI commonly requires statin therapy; omission at discharge is flagged by G9443 |
I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris | Chronic coronary disease where statin therapy is guideline-recommended; documentation needed if omitted |
I63.9 | Cerebral infarction, unspecified | Ischemic stroke is an indication for secondary prevention with statins; omission at discharge is relevant |
E78.5 | Hyperlipidemia, unspecified | Primary lipid disorder indicating need for statin therapy; omission documented when statin not prescribed |
Z79.899 | Other long term (current) drug therapy | Used to document long-term medication regimens; relevant when documenting absence of statin therapy on discharge |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99221 | Initial hospital care, typically 30 minutes at bedside | Admission evaluation that may document baseline indication for statin therapy prior to discharge |
99238 | Hospital discharge day management; 30 minutes | Discharge management visit where medication reconciliation and documentation of omission (G9443) occurs |
92928 | Percutaneous transluminal coronary angioplasty (with stent) — coronary artery stent placement | Procedure often preceding discharge in patients for whom statin therapy is indicated; statin omission would be noted at discharge |
96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | Potential inpatient medication administrations unrelated to statin prescription documented during hospitalization |
99495 | Transitional care management, moderate complexity | Post-discharge care planning that may address reasons for statin non-prescription and follow-up |