How To Use HCPCS Code G8965

HCPCS code G8965 describes a cardiac stress imaging test primarily performed on low CHD risk patients for initial detection and risk assessment. This code is used to identify a specific procedure and is essential for medical coders to accurately bill for the service. In this article, we will delve into the details of HCPCS code G8965, 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 G8965?

HCPCS code G8965 is a unique alphanumeric code that is used to identify a specific medical procedure. In this case, it represents a cardiac stress imaging test performed on low CHD risk patients for initial detection and risk assessment. It is important for medical coders to accurately assign this code to ensure proper billing and reimbursement.

2. Official Description

The official description of HCPCS code G8965 is “Cardiac stress imaging test primarily performed on low CHD risk patient for initial detection and risk assessment.” The short description for this code is “Csit perf on low chd rsk.” These descriptions provide a concise summary of the procedure that this code represents.

3. Procedure

1. The cardiac stress imaging test begins with the patient being prepared for the procedure. This may involve obtaining a detailed medical history, performing a physical examination, and obtaining informed consent.
2. The patient is then positioned on an examination table, and electrodes are placed on their chest to monitor their heart activity during the test.
3. A baseline set of images of the patient’s heart is taken using a specialized imaging technique, such as echocardiography or nuclear imaging.
4. The patient is then subjected to a controlled physical stress, such as exercise on a treadmill or administration of a pharmacological stress agent.
5. During the stress phase, additional images of the patient’s heart are taken to assess its function and blood flow.
6. After the stress phase, the patient is monitored for a period of time to ensure their safety and stability.
7. A final set of images is taken to compare with the baseline images and evaluate any changes or abnormalities.
8. The results of the cardiac stress imaging test are then analyzed by a qualified healthcare professional to determine the patient’s risk for coronary heart disease and guide further treatment or interventions.

4. When to use HCPCS code G8965

HCPCS code G8965 should be used when performing a cardiac stress imaging test on low CHD risk patients for initial detection and risk assessment. It is important to ensure that the patient meets the specific criteria for this procedure, as outlined in the official description of the code. Medical coders should carefully review the patient’s medical records and consult with the healthcare provider to determine if this code is appropriate.

5. Billing Guidelines and Documentation Requirements

When billing for the cardiac stress imaging test using HCPCS code G8965, healthcare providers need to ensure that the necessary documentation is in place. This may include the patient’s medical history, physical examination findings, informed consent, details of the procedure performed, and the results of the test. It is important to accurately capture and report all relevant information to support the medical necessity and appropriateness of the procedure.

6. Historical Information and Code Maintenance

HCPCS code G8965 was added to the Healthcare Common Procedure Coding System on January 01, 2013. 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. It is important for medical coders to stay updated on any changes or revisions to the code to ensure accurate billing and compliance with coding guidelines.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G8965 may vary depending on the specific policies and guidelines of each payer. It is important for healthcare providers to familiarize themselves with the coverage criteria and reimbursement rates for this procedure. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value is not established or applicable as HCPCS is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G8965 should be billed:

1. A 55-year-old male with a low CHD risk profile undergoes a cardiac stress imaging test for initial detection and risk assessment.
2. A 45-year-old female with a family history of coronary heart disease undergoes a cardiac stress imaging test to evaluate her risk.
3. A 60-year-old male with diabetes and hypertension undergoes a cardiac stress imaging test as part of his routine cardiovascular evaluation.
4. A 50-year-old female presents with atypical chest pain and undergoes a cardiac stress imaging test to assess her risk for coronary heart disease.
5. A 65-year-old male with a history of previous myocardial infarction undergoes a cardiac stress imaging test to monitor his cardiac function and assess his risk for future events.