Cardiology Coding Alert

Question: What’s the HCPCS code for Definity?

Iowa Subscriber

Answer: For payers like Medicare that accept Q codes, you should report Q9957 (Injection, perflutren lipid microspheres, per ml). If your payer does not accept Q codes, then A9700 (Supply of injectable contrast material for use in echocardiography, per study) is the appropriate choice. Pay attention to the differences in units for these two codes. Q9957 is per ml, while A9700 is per study.

Definity is a brand name for perfluten lipid microsphere. As a contrast agent, Definity helps the cardiologist get a better view of the left ventricle during echocardiography in patients with a history of echocardiograms that show insufficient anatomic definition without contrast. Be sure to report the echo as well, such as 93306 (Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography). Add modifier 26 (Professional component) if you’re reporting only the professional services for the echo.

Note that because of the potential for serious reactions, this agent comes with a warning to perform it with resuscitation equipment on hand.

Bonus tip: A facility would not report 93306. They would code the CMS global procedure HCPCS code C8929 (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) along with the Definity code Q9957. Facility coders should also review C8921-C8926 and C8928-C8930 for other Definity echocardiography options.