How To Use HCPCS Code G9746

HCPCS code G9746 describes a specific medical condition or situation in which a patient has mitral stenosis or prosthetic heart valves, or when a patient has a transient or reversible cause of atrial fibrillation (AF), such as pneumonia, hyperthyroidism, pregnancy, or cardiac surgery. This code is used to identify and document the specific circumstances under which the patient is experiencing these conditions.

1. What is HCPCS G9746?

HCPCS code G9746 is a unique alphanumeric code that is part of the Healthcare Common Procedure Coding System (HCPCS). It is used to identify and classify specific medical procedures, services, and supplies provided to patients. Each HCPCS code has a specific meaning and usage, allowing healthcare providers and medical coders to accurately document and bill for the services rendered.

2. Official Description

The official description of HCPCS code G9746 is “Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of AF (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery).” The short description for this code is “Mit sten, valve or trans af.”

3. Procedure

1. HCPCS code G9746 does not represent a specific procedure or treatment. Instead, it is used to indicate the presence of specific medical conditions or situations in a patient.
2. When documenting the use of this code, healthcare providers should clearly indicate whether the patient has mitral stenosis, prosthetic heart valves, or a transient/reversible cause of AF.
3. It is important to provide detailed and accurate information in the medical record to support the use of this code.

4. When to use HCPCS code G9746

HCPCS code G9746 should be used when a patient has been diagnosed with mitral stenosis, has prosthetic heart valves, or has a transient or reversible cause of AF. The code is used to indicate the specific medical condition or situation that the patient is experiencing.

It is important to note that this code should only be used when the patient meets the specific criteria outlined in the official description. If the patient does not have any of the specified conditions, this code should not be used.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies associated with HCPCS code G9746, healthcare providers should ensure that the medical record includes the following documentation:

• Confirmation of the presence of mitral stenosis, prosthetic heart valves, or a transient/reversible cause of AF
• Supporting clinical documentation, such as diagnostic test results or medical reports
• Any additional information necessary to justify the medical necessity of the services or supplies provided

6. Historical Information and Code Maintenance

HCPCS code G9746 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of the effective date, 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

The coverage and pricing of HCPCS code G9746 may vary depending on the specific insurance provider. It is important to consult the Medicare or insurance guidelines to determine whether this code is payable and how it is priced.

The pricing indicator code for HCPCS code G9746 is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code G9746 should be billed:

1. A patient with mitral stenosis undergoes a cardiac procedure.
2. A patient with prosthetic heart valves develops atrial fibrillation due to pneumonia.
3. A pregnant patient with mitral stenosis requires monitoring for atrial fibrillation.
4. A patient recovering from cardiac surgery experiences transient atrial fibrillation.
5. A patient with hyperthyroidism develops atrial fibrillation.