A report has been compiled listing procedure codes for submitting a claim for a procedure using ICG.

Always verify coding requirements with the relevant payer. Coding requirements may vary by insurer or plan; please refer to the payer-specific policies to understand what codes may be covered. Check with the relevant payers regarding guidance on which diagnoses and procedures they will recognize. Health care professionals are solely responsible for selecting codes that appropriately reflect the patient’s diagnosis, the services rendered, and the applicable payer’s guidelines.

These procedure codes apply to dates of service on or after October 1, 2015, the date that ICD-10-CM codes came into use. Providers should document the procedure with a sufficiently high degree of specificity based on the information available at the time to enable the identification of the most appropriate code.

  • 4A12XSH Monitoring of Cardiac Vascular Perfusion using Indocyanine Green Dye, External Approach
  • 4A1GXSH Monitoring of Skin and Breast Vascular Perfusion using Indocyanine Green Dye, External Approach
  • 4A1BXSH Monitoring of Gastrointestinal Vascular Perfusion using Indocyanine Green Dye, External Approach
  • 4A1605H Monitoring of Lymphatic Flow using Indocyanine Green Dye, Open Approach
  • 4A1635H Monitoring of Lymphatic Flow using Indocyanine Green Dye, Percutaneous Approach
  • 4A1675H Monitoring of Lymphatic Flow using Indocyanine Green Dye, Via Natural or Artificial Opening
  • 4A1685H Monitoring of Lymphatic Flow using Indocyanine Green Dye, Via Natural or Artificial Opening Endoscopic
  • 8E090EZ Fluorescence guided procedure of head and neck region, Open Approach
  • 8E093EZ Fluorescence guided procedure of head and neck region, Percutaneous Approach
  • 8E094EZ Fluorescence guided procedure of head and neck region, Percutaneous Endoscopic Approach
  • 8E097EZ Fluorescence guided procedure of head and neck region, via natural or artificial opening
  • 8E0W0EZ Fluorescence guided procedure of trunk region, Open Approach
  • 8E0W3EZ Fluorescence guided procedure of trunk region, Percutaneous Approach
  • 8E0W4EZ Fluorescence guided procedure of trunk region, Percutaneous Endoscopic Approach
    https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-PCS.html

The Following Codes will be effective on October 1, 2020

  • BF50200 Bile Duct, Indocyanine Green Dye, Intraoperative
  • BF53200 Bile Duct and Gallbladder, Indocyanine Green Dye, Intraoperative
  • BF52200 Gallbladder, Indocyanine Green Dye, Intraoperative
  • BF53200 Gallbladder and Bile Duct, Indocyanine Green Dye, Intraoperative
  • BF5C200 Hepatobiliary System, All, Indocyanine Green Dye, Intraoperative
  • BF55200 Liver, Indocyanine Green Dye, Intraoperative
  • BF56200 Spleen and Liver, Indocyanine Green Dye, Intraoperative

Indications for Use for
Indocyanine Green for Injection, USP are:

  • Determining Cardiac Output, Hepatic Function, and Liver Blood Flow
  • Ophthalmic Angiography

Supply of

1.15rem;”>Indocyanine Green for Injection USP is supplied in a kit (NDC 70100-424-02) containing six 25 mg Indocyanine Green for Injection USP vials and six 10 mL Sterile Water for Injection, USP plastic vials:

  • NDC 70100-424-01 Indocyanine Green for Injection USP vial 25 mg fill in 25 mL vial.
  • NDC 63323-185-10 (or NDC 0409-4887-17) Sterile Water for Injection, USP, 10 mL fill in 10 mL plastic vials.

The information available in this guide is compiled from sources believed to be accurate, but the International Society for Fluorescence Guided Surgery (ISFGS) makes no representation that it is accurate. This information is subject to change. Payer coding requirements may vary or change over time, so it is important to regularly check with each payer regarding the payer-specific requirements. The information available here is not intended to be conclusive, nor is it intended to replace the guidance of a qualified professional advisor. ISFGS and its agents make no warranties or guarantees, expressed or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs. You are solely responsible for determining the appropriate codes and for any action you take in billing. Consult the relevant payer manual and/or other guidelines for a description of each code to determine the appropriateness of a particular code and for information on additional codes. Diagnosis codes should be selected only by a health care professional.

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