Starting January 1 , 2025, the Centers for Medicare and Medicaid Services (CMS) introduced two new G codes to reimburse atherosclerotic cardiovascular disease (ASCVD) risk assessment and management services.
We will talk about the G0537 this month and G0538 next time. We want every healthcare provider to understand the value and the ease of using these codes with software applications by CompuGroup Medical.
Implementing the services for these new codes could effectuate a 4% reduction in overall patient mortality and an 11% reduction in deaths due to cardiovascular deaths in patients who score in the medium and high risk classifications.
How to implement G0537
The ASCVD risk assessment G code—G0537—is defined as the "administration of a standardized, evidence-based Atherosclerotic Cardiovascular Disease Risk Assessment for patients with ASCVD risk factors, 5-15 minutes, not more often than every 12 months per practitioner."
We suggest using this code during every Annual Wellness Visit.
This billable service must be performed with patients that do not currently have a cardiovascular disease diagnosis or history of heart attack or stroke. That is a key part of this new G code.
Your patient must have at least one predisposing condition that may put them at increased risk for future ASCVD diagnosis. Qualifying conditions include, but are not limited to:
- obesity
- family history of cardiovascular disease
- high blood pressure
- high cholesterol
- smoking/alcohol/drug use
- prediabetes or diabetes
Look over this list carefully, and you will find that almost all of your patients fall into this list.
Calculating a patient's cardiovascular risk
There is not a specified tool that must be used for this assessment. I use the Mayo Clinic cardiovascular risk calculator. I like this tool, because you can copy and paste the results into the electronic medical record.
At my practice, I have this linked as an add on to CGM APRIMA. You should set up this link in your EHR so it is one click away. Speak to support to get this done for you.
Some of the information you'll want handy for the risk calculator includes:
- Age
- Sex
- Race
- Most recent LDL
- Most recent Total Cholesterol
- Most recent HDL
- Is the patient on a lipid lowering medication?
- Does the patient have diabetes?
- Does the patient have hypertension?
- Is the patient a smoker?
- History of heart attack in immediate family (biological parents, siblings, or children)?
You will then receive the patient's ASCVD risk score:
- <5% = low risk
- 5%–<7.5% = borderline risk
- >7.5%–<20% = intermediate risk
- >20% = high risk
I have built this into our chief complaints within CGM APRIMA. This will complete the G0537 and generate $21.57 in New York City, where I'm located, with 0.18 w RVUs.
You can quickly build this into the chief complaint, plan, and other templates found in the electronic health record systems by CompuGroup Medical. This helps guide you to consider and then complete the G0537, generating about $21—depending on your locality—in additional, quality-oriented revenue and 0.18 wRVUs.
If you quantify the risk and calculate an intermediate or high ASCVD risk, you can bill a G0538 monthly. More on that next time.