How To Use HCPCS Code G8694
HCPCS code G8694 describes the left ventricular ejection fraction (LVEF) being less than or equal to 40% or documentation of moderate or severe left ventricular systolic dysfunction (LVSD). This code is used to indicate a specific condition related to the heart’s pumping function and is important for accurate medical coding and billing.
1. What is HCPCS G8694?
HCPCS code G8694 is a specific code used in medical coding to identify the left ventricular ejection fraction (LVEF) being less than or equal to 40% or documentation of moderate or severe left ventricular systolic dysfunction (LVSD). This code helps healthcare providers and insurance companies accurately document and bill for services related to this condition.
2. Official Description
The official description of HCPCS code G8694 is “Left ventricular ejection fraction (LVEF) < = 40% or documentation of moderate or severe LVSD." The short description is "LVEF <=40%." This description clearly indicates the specific condition that this code represents.
3. Procedure
- Perform a comprehensive evaluation of the patient’s cardiac function.
- Measure the left ventricular ejection fraction (LVEF) using an appropriate imaging technique, such as echocardiography or cardiac magnetic resonance imaging (MRI).
- Determine if the LVEF is less than or equal to 40% or if there is documentation of moderate or severe left ventricular systolic dysfunction (LVSD).
- Document the findings and include them in the patient’s medical record.
4. When to use HCPCS code G8694
HCPCS code G8694 should be used when the patient’s left ventricular ejection fraction (LVEF) is less than or equal to 40% or when there is documentation of moderate or severe left ventricular systolic dysfunction (LVSD). This code is used to indicate a specific cardiac condition and is important for accurate medical coding and billing.
5. Billing Guidelines and Documentation Requirements
When billing for services related to HCPCS code G8694, healthcare providers need to document the patient’s LVEF measurement and any documentation of moderate or severe left ventricular systolic dysfunction (LVSD). This documentation should be included in the patient’s medical record and submitted along with the appropriate billing codes.
6. Historical Information and Code Maintenance
HCPCS code G8694 was added to the Healthcare Common Procedure Coding System on January 01, 2012. As of January 01, 2023, 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 a pricing indicator code of 00, which means it is not separately priced by Part B and is bundled or not covered by Medicare.
7. Medicare and Insurance Coverage
HCPCS code G8694 is covered by Medicare, but it is not separately priced by Part B. The pricing indicator code 00 indicates that the service is not separately priced and may be bundled with other services or not covered by Medicare. The multiple pricing indicator code 9 indicates that the value for this code is not established. It is important for healthcare providers to understand the coverage and pricing guidelines of Medicare and other insurance companies when billing for services related to this code.
8. Examples
Here are five examples of when HCPCS code G8694 should be billed:
- A patient undergoes an echocardiogram, and the results show a left ventricular ejection fraction (LVEF) of 35%.
- A patient’s medical record includes documentation of moderate left ventricular systolic dysfunction (LVSD) based on previous cardiac imaging studies.
- A patient with a history of heart failure presents with symptoms of worsening left ventricular systolic dysfunction (LVSD) and undergoes a cardiac MRI, which confirms the diagnosis.
- A patient with a known LVEF of 40% undergoes a follow-up echocardiogram, which shows a decrease in LVEF to 35%.
- A patient with a history of heart disease undergoes a stress echocardiogram, and the results indicate a left ventricular ejection fraction (LVEF) of 38%.
