How To Use HCPCS Code G8923

HCPCS code G8923 describes the condition of left ventricular ejection fraction (LVEF) being equal to or less than 40% or documentation of moderately or severely depressed left ventricular systolic function. This code is used to identify patients with impaired heart function, specifically in the left ventricle. In this article, we will explore the details of HCPCS code G8923, 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 G8923?

HCPCS code G8923 is a specific code used in medical coding to identify patients with a left ventricular ejection fraction (LVEF) of 40% or lower or documentation of moderately or severely depressed left ventricular systolic function. This code is essential for accurately documenting and billing for patients with impaired heart function.

2. Official Description

The official description of HCPCS code G8923 is “Left ventricular ejection fraction (LVEF) <= 40% or documentation of moderately or severely depressed left ventricular systolic function." The short description for this code is "LVEF <= 40% or LVSD." These descriptions provide a clear understanding of the condition being identified by this code.

3. Procedure

  1. The procedure for HCPCS code G8923 involves assessing the patient’s left ventricular ejection fraction (LVEF) through various diagnostic tests, such as echocardiography, cardiac MRI, or nuclear imaging.
  2. The healthcare provider will review the test results and determine if the patient’s LVEF is equal to or less than 40% or if there is documentation of moderately or severely depressed left ventricular systolic function.
  3. If the patient meets the criteria specified in the code, the healthcare provider will assign HCPCS code G8923 to accurately document the patient’s condition.

4. When to use HCPCS code G8923

HCPCS code G8923 should be used when a patient’s left ventricular ejection fraction (LVEF) is equal to or less than 40% or when there is documentation of moderately or severely depressed left ventricular systolic function. This code is used to identify patients with impaired heart function and is crucial for accurate documentation and billing purposes.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8923, healthcare providers need to ensure proper documentation of the patient’s LVEF or documentation of moderately or severely depressed left ventricular systolic function. The medical record should include the test results and any other relevant clinical information supporting the use of this code. It is essential to follow the specific billing guidelines provided by the payer to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G8923 was added to the Healthcare Common Procedure Coding System on January 01, 2013. As of the effective date 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 been in use for a significant period without any significant changes or revisions.

7. Medicare and Insurance Coverage

HCPCS code G8923 may be covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This indicates that the service may be bundled or not covered by Medicare. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS code G8923 is not priced separately by Part B. The coverage and reimbursement for this code may vary depending on the specific payer’s policies and guidelines.

8. Examples

Here are five examples of when HCPCS code G8923 should be billed:

  1. A patient undergoes an echocardiogram, and the results indicate a left ventricular ejection fraction (LVEF) of 35%. The healthcare provider assigns HCPCS code G8923 to accurately document the patient’s impaired heart function.
  2. A patient with a history of heart failure presents with symptoms of worsening heart function. The healthcare provider orders a cardiac MRI, which reveals severely depressed left ventricular systolic function. HCPCS code G8923 is assigned to document the patient’s condition.
  3. A patient with a known LVEF of 40% undergoes a follow-up echocardiogram, which shows a further decrease in LVEF to 30%. HCPCS code G8923 is used to indicate the worsening of the patient’s heart function.
  4. A patient with a history of heart disease undergoes a nuclear imaging test, which demonstrates moderately depressed left ventricular systolic function. HCPCS code G8923 is assigned to accurately document the patient’s condition.
  5. A patient with a recent myocardial infarction undergoes an echocardiogram, which reveals severely depressed left ventricular systolic function. HCPCS code G8923 is used to indicate the impaired heart function resulting from the myocardial infarction.

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