Summary & Overview

HCPCS G8396: Left Ventricular Ejection Fraction Not Performed or Documented

HCPCS Level II code G8396 denotes that left ventricular ejection fraction (LVEF) was not performed or not documented during an encounter. Nationally, tracking documentation gaps for LVEF is important because LVEF informs diagnosis, risk stratification, and treatment choices in heart failure and other cardiac conditions. Identifying instances where LVEF is missing supports quality measurement, care coordination, and documentation improvement efforts.

Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical context, expected service settings, and the role this code plays in quality reporting and medical record completeness. The analysis highlights typical use cases, implications for claims processing, and where to look for related clinical documentation in patient records.

This publication provides national-level context rather than state-specific guidance. It summarizes what the code represents, the clinical scenarios that commonly generate the code, and what stakeholders—payers, providers, and compliance teams—should recognize when encountering G8396 on a claim. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG8396HCPCS Level IIleft ventricular ejection fractionLVEF documentationcardiologyquality measurementmedical documentationechocardiographyclaims coding

Billing Code Overview

HCPCS Level II code G8396 indicates left ventricular ejection fraction (LVEF) not performed or documented. The code is used to identify encounters in which LVEF assessment was expected but either the test was not performed or the result was not recorded in the medical record.

Service type: Cardiac diagnostic assessment / documentation exception

Typical site of service: Inpatient or outpatient cardiology settings where LVEF measurement is ordinarily obtained, such as hospital cardiology units, echocardiography laboratories, and outpatient cardiology clinics.

Clinical & Coding Specifications

Clinical Context

A common scenario involves an outpatient cardiology clinic visit or hospital follow-up for a patient with known or suspected heart failure or ischemic heart disease where assessment of left ventricular systolic function is indicated. For example, a 68-year-old patient with progressive dyspnea, lower extremity edema, and a history of prior myocardial infarction presents for evaluation. The clinician documents symptoms, physical exam, and orders an imaging study to measure left ventricular ejection fraction (LVEF), typically transthoracic echocardiography (TTE). If the LVEF measurement is not performed (e.g., imaging incomplete, image quality inadequate, study not performed) or not documented in the medical record, the billing code G8396 is used to indicate that LVEF was not performed or documented. Typical workflow: history and exam → order TTE or other LVEF-capable study (TTE, MUGA, cardiac MRI) → attempt to obtain LVEF measurement during study → document result in report and medical record. Typical site of service includes outpatient cardiology clinic with referral to an imaging lab, hospital inpatient ward, or outpatient diagnostic imaging center where echocardiography or other cardiac imaging is performed.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to manage or document inability to obtain LVEF is substantially greater than typical (rare for this code).
`23`	Unusual anesthesia	Use when general anesthesia was required for the imaging procedure and is unusual for the service.
`52`	Reduced services	Use when the imaging study was partially completed but LVEF measurement was not obtained due to limited scope.
`53`	Discontinued procedure	Use when the imaging procedure was started but terminated before LVEF assessment for patient safety or intolerance.
`54`	Surgical care only	Generally not applicable; may be used when only perioperative care is billed separate from imaging.
`55`	Postoperative management only	Use when only postoperative evaluation is billed and no LVEF documentation is performed.
`56`	Preoperative management only	Use when only preoperative evaluation occurs without obtaining LVEF.
`62`	Two surgeons	Rarely applicable; use when two surgeons are required for a concurrent procedure and LVEF not documented in periop record.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when advanced practice clinician documents care and LVEF not performed; applicability depends on payor rules.
`CO`	Left co-surgeon	Use when co-surgeon involvement is billed and LVEF not documented in operative records.
`CQ`	Service furnished under a Medicare-approved APM	Use when service is part of an Alternative Payment Model and documentation lacks LVEF.
`FX`	Primary fracture fixation	Not typically applicable; rarely used if procedure context involves fracture care where LVEF not documented.
`FY`	Discontinued resuscitative services	Use if resuscitative efforts interrupted imaging and LVEF not obtained.
`QK`	Medical direction of two, three, or four assistants	Use when medical direction documented and LVEF missing in the medical record.
`QX`	Certified registered nurse anesthetist service	Use when CRNA provides anesthesia and imaging was not completed to obtain LVEF.

Taxonomy Code	Specialty	Notes
207RC0000X	Cardiology	Cardiology physicians commonly order and interpret LVEF assessments and document results.
207RN0400X	Adult Congenital Cardiology	Specialists managing complex structural heart disease who require LVEF assessment.
207RH0000X	Interventional Cardiology	Interventionalists who require LVEF information for procedural planning.
207L00000X	Internal Medicine	Hospitalists and internists who manage heart failure and may document absence of LVEF.
363A00000X	Radiology – Diagnostic	Diagnostic radiologists or cardiac imaging specialists performing cardiac MRI or nuclear studies to assess LVEF.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.9`	Heart failure, unspecified	Heart failure patients commonly require LVEF assessment for diagnosis, staging, and management decisions.
`I50.22`	Chronic systolic (congestive) heart failure	Systolic dysfunction requires LVEF measurement to quantify severity and guide therapy.
`I25.2`	Old myocardial infarction	Prior MI patients need LVEF assessment to evaluate remodeling and ischemic cardiomyopathy.
`I42.0`	Dilated cardiomyopathy	LVEF measurement documents severity of ventricular dilation and systolic dysfunction.
`R06.02`	Shortness of breath, orthopnea	Symptom prompting evaluation, often leads to LVEF testing.
`I48.91`	Unspecified atrial fibrillation	Atrial fibrillation patients may need LVEF assessment for rate control and anticoagulation decisions.
`I50.1`	Left ventricular failure	Directly related to LVEF assessment to quantify left ventricular systolic performance.
`I21.9`	Acute myocardial infarction, unspecified	Acute MI patients require early assessment of LVEF for risk stratification.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`93306`	Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed; complete, with spectral Doppler and color flow Doppler imaging	Primary diagnostic study commonly performed to measure LVEF; if performed, should document LVEF rather than use `G8396`.
`93350`	Doppler echocardiography, pulsed wave and/or continuous wave and/or color flow velocity recording	Performed alongside TTE to quantify flow and support LVEF assessment.
`75559`	Magnetic resonance imaging, heart, with contrast, including flow and function when performed; without and with contrast material	Cardiac MRI can provide volumetric LVEF assessment when echocardiography is inadequate.
`78451`	Myocardial perfusion imaging, single study, planar imaging (e.g., MUGA)	Nuclear medicine technique used to evaluate ventricular function including LVEF; alternative when echocardiography is not suitable.
`71045`	Chest radiograph, single view, frontal	Often performed adjunctively but does not measure LVEF; may be done when LVEF measurement is not completed.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Clinician visit during which LVEF is ordered or noted as not performed; documentation of reason for absence may be required for quality reporting.