G9298 HCPCS Reimbursement & Benchmarks

HCPCS Level II code G9298 captures a focused preoperative evaluation for venous thromboembolic and cardiovascular risk factors performed within 30 days before a procedure. This code reflects attention to patient histories of deep vein thrombosis, pulmonary embolism, myocardial infarction, arrhythmia, and stroke — conditions that can materially affect perioperative planning and patient safety. Nationally, standardized reporting of such evaluations supports surgical risk stratification, appropriate prophylaxis decisions, and communication across care teams.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of the code’s clinical intent, typical sites of service, common modifiers associated with billing of this service, and where available, payer coverage contexts. The publication also outlines benchmarking elements, policy considerations affecting preoperative evaluations, and clinical context that informs appropriate use.

Data not available in the input includes specific ICD-10 diagnoses, associated taxonomies, and related billing codes.

Billing Code Overview

HCPCS Level II code G9298 describes evaluation of patients for venous thromboembolic and cardiovascular risk factors within 30 days prior to a procedure. The description cites assessment of histories such as deep vein thrombosis (dvt), pulmonary embolism (pe), myocardial infarction (mi), arrhythmia, and stroke.

Service type: Pre-procedural cardiovascular and thromboembolic risk evaluation
Typical site of service: Outpatient clinic or preoperative evaluation setting (including procedural clinics and ambulatory surgical centers)

Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical Context

A 68-year-old male with a history of atrial fibrillation and prior deep vein thrombosis is scheduled for an elective total knee arthroplasty. Within 30 days prior to the procedure the preoperative clinic performs a focused evaluation for venous thromboembolic and cardiovascular risk factors. The evaluation includes a targeted history (prior DVT/PE, myocardial infarction, arrhythmias, stroke), review of current anticoagulant/antiplatelet therapy, medication reconciliation, baseline vital signs, focused cardiopulmonary exam, and review of relevant recent diagnostic testing (e.g., ECG, echocardiogram, duplex ultrasound reports if available). The clinician documents risk assessment, perioperative anticoagulation plan, and any recommendations for perioperative monitoring or prophylaxis.

A typical workflow: the patient is seen in preoperative clinic 7–21 days before surgery; the clinician reviews records and medications, performs the focused assessment, documents findings and risk stratification in the medical record, communicates the plan to the surgical and anesthesia teams, and places orders for appropriate perioperative prophylaxis or monitoring. If findings change within 30 days (new arrhythmia, recurrent DVT, or recent cardiac event), the evaluation is updated and re-documented prior to the procedure.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services	When work required is substantially greater than typical for the service due to complex preoperative evaluation for thromboembolic/cardiac risk.

Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopedic Surgery	Common surgeon ordering the preoperative VTE/CV risk evaluation for joint replacement.
`207P00000X`	Anesthesiology	Performs preoperative risk assessment and documents perioperative anesthesia-related risk.
`207Q00000X`	Cardiology	Consulted for patients with active cardiac disease or arrhythmia management prior to surgery.
`363A00000X`	Internal Medicine	Hospitalists or internists conducting comprehensive preoperative evaluations and medication management.
`2083P0800X`	Vascular Surgery	Consulted when prior DVT/PE or venous disease requires specialist input.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I48.91`	Unspecified atrial fibrillation	Atrial fibrillation is a major cardiovascular risk factor affecting perioperative anticoagulation and thromboembolism risk.
`I26.99`	Other pulmonary embolism without acute cor pulmonale	Prior PE indicates elevated perioperative VTE risk and influences prophylaxis and workup.
`I82.401`	Acute embolism and thrombosis of deep veins of unspecified lower extremity, unspecified	Prior or recent DVT increases risk for recurrent thromboembolism around surgery.
`I21.9`	Acute myocardial infarction, unspecified	Recent MI significantly impacts perioperative cardiac risk and timing of elective procedures.
`I63.9`	Cerebral infarction, unspecified	Prior stroke/CVA alters perioperative neurologic and anticoagulation management.
`Z98.891`	Personal history of pulmonary embolism	Documented history of PE impacts prophylactic strategies and surveillance.
`Z95.2`	Presence of prosthetic heart valve	Presence of valve prosthesis affects perioperative anticoagulation planning.
`Z79.01`	Long term (current) use of anticoagulants	Current anticoagulant therapy requires perioperative management and medication reconciliation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99203`	Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity	May be used for a comprehensive preoperative evaluation visit when a new preoperative assessment is performed.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Common for focused preoperative assessments in established surgical patients.
`93000`	Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report	Frequently ordered and documented as part of cardiac risk evaluation prior to surgery.
`93970`	Duplex scan of extremity veins (non-invasive) complete bilateral study	Ordered when concern for active DVT exists and prior history or symptoms warrant duplex imaging.
`93306`	Echocardiography, transthoracic, real-time with image documentation, complete, with interpretation and report	Ordered when cardiac structural or functional assessment is required as part of perioperative cardiovascular risk stratification.

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Summary & Overview

HCPCS G9298: Preoperative Venous Thromboembolic and Cardiovascular Risk Evaluation