How To Use HCPCS Code G8738

HCPCS code G8738 describes the left ventricular ejection fraction (LVEF) being less than 40% or documentation of severely or moderately depressed left ventricular systolic function. This code is used to identify patients with impaired left ventricular function, which is an important indicator of heart health and function. In this article, we will explore the details of HCPCS code G8738, 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 G8738?

HCPCS code G8738 is a specific code used in medical coding to identify patients with a left ventricular ejection fraction (LVEF) less than 40% or documentation of severely or moderately depressed left ventricular systolic function. This code is important in assessing the functioning of the heart and is used to indicate impaired left ventricular function.

2. Official Description

The official description of HCPCS code G8738 is “Left ventricular ejection fraction (LVEF) < 40% or documentation of severely or moderately depressed left ventricular systolic function." The short description for this code is "LVEF < 40%." These descriptions accurately represent the purpose and criteria for using this code.

3. Procedure

1. Perform a thorough assessment of the patient’s left ventricular ejection fraction (LVEF) using appropriate diagnostic tests such as echocardiography, cardiac MRI, or nuclear imaging.
2. Determine if the patient’s LVEF is less than 40% or if there is documentation of severely or moderately depressed left ventricular systolic function.
3. If the patient meets the criteria, assign HCPCS code G8738 to indicate the impaired left ventricular function.

4. When to use HCPCS code G8738

HCPCS code G8738 should be used when a patient’s left ventricular ejection fraction (LVEF) is less than 40% or when there is documentation of severely or moderately depressed left ventricular systolic function. This code is used to indicate impaired left ventricular function and is important for assessing the patient’s heart health.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8738, healthcare providers need to document the patient’s LVEF measurement or the documentation of severely or moderately depressed left ventricular systolic function. This documentation should be included in the patient’s medical record and should support the use of this specific code. When submitting the claim, the code G8738 should be included along with any other relevant diagnosis and procedure codes.

6. Historical Information and Code Maintenance

HCPCS code G8738 was added to the Healthcare Common Procedure Coding System on January 1, 2012. It has an effective date of January 1, 2015. This code was terminated on December 31, 2014, which means it is no longer in use. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G8738 may vary. It is important to check with the specific payer to determine if this code is payable. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. The multiple pricing indicator code is 9, which indicates that the value is not established. This means that the pricing indicator is not applicable for this code.

8. Examples

Here are five examples of when HCPCS code G8738 should be billed:

1. A patient undergoes an echocardiogram, and the results indicate a left ventricular ejection fraction of 35%. HCPCS code G8738 should be used to indicate the impaired left ventricular function.
2. A patient’s medical record includes documentation of severely depressed left ventricular systolic function. HCPCS code G8738 should be assigned to indicate the impaired left ventricular function.
3. A patient’s cardiac MRI shows a left ventricular ejection fraction of 38%. HCPCS code G8738 should be used to indicate the impaired left ventricular function.
4. A patient’s nuclear imaging results indicate moderately depressed left ventricular systolic function. HCPCS code G8738 should be assigned to indicate the impaired left ventricular function.
5. A patient’s echocardiogram shows a left ventricular ejection fraction of 42%. HCPCS code G8738 should not be used in this case as the LVEF is not less than 40%.