HCPCS code C8929: Transthoracic echocardiography with contrast

Learn more about HCPCS code C8929, its documentation and billing requirements for proper use and billing, from our short guide.

Use Code

## **What is HCPCS code C8929?** HCPCS code C8929 stands for "Transthoracic echocardiography with contrast, or without contrast, followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography." The code describes a complete transthoracic echocardiogram (TTE) performed in real time (2D) that may be done either with contrast initially or without contrast, followed by contrast. It includes M-mode recording when done, complete image documentation, and incorporates both spectral Doppler and color flow Doppler echocardiography. It is an HCPCS Level II “C-codes”, designed for hospital outpatient billing when echocardiography with contrast is utilized, distinguishing it from standard CPT Level I codes This procedure is a non-invasive diagnostic test that uses ultrasound to create detailed images of the heart's structure and function. The key aspect of this code is the use of a contrast agent, which is administered intravenously to enhance the clarity of the images, making it easier to visualize the heart chambers and borders. It also includes the use of spectral and color flow Doppler to evaluate blood flow patterns and velocities within the heart. The purpose of this exam is to diagnose and monitor various heart conditions, such as: - Heart valve diseases - Cardiomyopathies - Congenital heart defects - Unexplained heart murmurs - Suspected heart failure or myocardial infarction The procedure is typically performed by a sonographer under the supervision of a cardiologist, who interprets the results.

## **HCPCS code C8929 documentation requirements** Thorough and accurate documentation is essential for proper billing and to demonstrate medical necessity. Key documentation requirements for C8929 include: - **Clinical indication**: The patient's medical record must clearly state the reason for the exam, supported by symptoms (e.g., chest pain, shortness of breath) or a suspected diagnosis. - **Detailed report**: The echocardiogram report should include an interpretation of the images, quantitative measurements (e.g., LV dimensions, wall thickness), and a description of any clinically relevant or abnormal findings. - **Use of contrast**: The documentation must specify that a contrast agent was used to enhance the study and why it was medically necessary (e.g., suboptimal images without contrast). - **Complete study**: The report should confirm that a complete study was performed, including multiple 2D views of all heart chambers and valves, and that M-mode, spectral doppler, and color flow doppler techniques were used. If any views were not possible, the report should document the reason. - **Recorded studies**: The images must be recorded and available for future review.

## **C8929 billing requirements** To prevent denial of claims, the following requirements must be considered: - **Hospital outpatient code**: C8929 is a HCPCS Level II "C" code, which means it is primarily used by hospital outpatient departments for billing services provided to Medicare patients under the Outpatient Prospective Payment System (OPPS). It is not typically used for physician office billing, though some commercial payers may have different policies. - **Contrast agent**: When billing C8929, the hospital should also report the specific HCPCS "Q" code for the contrast agent used (e.g., Q9957 for Definity). - **Separate procedures**: The services for the intravenous (IV) insertion and the injection of the contrast agent are bundled into the procedure code and should not be billed separately. - **Medical necessity**: Claims must be supported by a diagnosis code that demonstrates medical necessity. Medicare and other payers have specific lists of covered ICD-10 codes. - **Modifiers**: Depending on the billing scenario, a modifier may be necessary. For example, in a split-billing scenario where a physician and a facility are billing separately for the same procedure, the physician may need to append modifier -26 to the relevant CPT code to denote the professional component.

## **Other relevant codes** Relevant codes associated with echocardiography contrast procedures include: - **CPT code 93306**: This is the equivalent CPT code for a complete transthoracic echocardiogram with spectral and color flow doppler, but it is for a study performed without a contrast agent. It is often used by physicians in a private practice setting. C8929 is the hospital outpatient equivalent of this service, with the addition of contrast. - **CPT code 93308**: This code is for a limited or follow-up transthoracic echocardiogram. - **HCPCS code C8921**: Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete - **HCPCS code C8926**: Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report - **HCPCS code C8928**: This code is used for a transthoracic echo with contrast performed during a stress test (using a treadmill, bicycle, or pharmacological agents) without continuous ECG monitoring. - **HCPCS code C8930:** Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision - **HCPCS "Q" codes**: These codes are for the contrast agents themselves. Examples include Q9957 (Injection, perflutren lipid microspheres), Q9956 (Injection, perflutren protein-type a microspheres), and Q9955 (Injection, perflutren lipid microspheres with sulfur hexafluoride gas).

Frequently asked questions

No, you cannot report C8929 and a contrast agent Q-code separately for reimbursement under Medicare OPPS. The payment for C8929 already includes the contrast material when used, so the Q-code would be denied as bundled. Some commercial payers may allow separate reporting, but this depends on individual payer policy.

Generally, no. "C" codes are temporary codes created by Medicare specifically for hospital outpatient services under OPPS. Physicians' offices should typically use the corresponding CPT codes, such as 93306, and bill for the contrast agent with a separate "Q" code. It's always best to verify with the specific payer's guidelines.

Clinical records must note the justification for contrast (e.g., poor acoustic window), specify the contrast agent and volume, and confirm completion of all required imaging components: 2D, M-mode (if done), spectral Doppler, and color Doppler.