How To Use HCPCS Code G8396

HCPCS code G8396 describes the situation where the left ventricular ejection fraction (LVEF) is not performed or documented. This code is used to indicate that the LVEF measurement was not conducted or recorded during a specific medical procedure or encounter. In this article, we will explore the details of HCPCS code G8396, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G8396?

HCPCS code G8396 is used to identify cases where the left ventricular ejection fraction (LVEF) measurement was not performed or documented. The LVEF is a measurement that assesses the pumping efficiency of the left ventricle of the heart. It is an important indicator of cardiac function and is often used to evaluate patients with heart failure or other cardiovascular conditions.

2. Official Description

The official description of HCPCS code G8396 is “Left ventricular ejection fraction (LVEF) not performed or documented.” The short description for this code is “LVEF not performed.”

3. Procedure

1. The provider should assess the patient’s medical history and current condition to determine if an LVEF measurement is necessary.
2. If the decision is made to perform an LVEF measurement, the provider should follow the appropriate guidelines and protocols for conducting the procedure.
3. The LVEF measurement can be obtained through various methods, such as echocardiography, cardiac magnetic resonance imaging (MRI), or radionuclide imaging.
4. The provider should accurately record the LVEF measurement in the patient’s medical documentation.

4. When to use HCPCS code G8396

HCPCS code G8396 should be used when the left ventricular ejection fraction (LVEF) measurement was not performed or documented during a specific medical encounter. This may occur due to various reasons, such as technical difficulties, patient factors, or clinical judgment.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8396, healthcare providers should ensure that the absence of LVEF measurement is clearly documented in the patient’s medical records. This documentation should include the reason why the measurement was not performed or documented. It is important to provide accurate and detailed information to support the use of this code.

6. Historical Information and Code Maintenance

HCPCS code G8396 was added to the Healthcare Common Procedure Coding System on January 01, 2008. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has remained unchanged since its inception.

7. Medicare and Insurance Coverage

HCPCS code G8396 is classified under the coverage code C, which indicates that the determination of coverage is based on carrier judgment. This means that Medicare or other insurance carriers will make a decision on whether to cover the service or supply based on their own policies and guidelines. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the service may be bundled or not covered by Medicare or other insurers.

8. Examples

Here are five examples of scenarios where HCPCS code G8396 should be billed:

1. A patient undergoes a cardiac catheterization procedure, but the left ventricular ejection fraction (LVEF) measurement was not performed due to technical difficulties.
2. A patient with a history of heart failure visits a cardiologist for a routine check-up. The LVEF measurement is not performed during the visit.
3. A patient presents to the emergency department with chest pain. The LVEF measurement is not performed as the focus is on immediate medical intervention.
4. A patient undergoes a stress echocardiogram, but the LVEF measurement is not documented in the report.
5. A patient with a known LVEF measurement from a previous encounter visits a different healthcare provider for a follow-up visit. The LVEF measurement is not repeated during the visit.