How To Use HCPCS Code G0252

HCPCS code G0252 describes the procedure for pet imaging using full and partial-ring pet scanners for the initial diagnosis of breast cancer and/or surgical planning for breast cancer. This code is specifically used for the initial staging of axillary lymph nodes and is not covered by Medicare.

1. What is HCPCS G0252?

HCPCS code G0252 is a specific code used to identify the procedure of pet imaging for the initial diagnosis of breast cancer and/or surgical planning for breast cancer. It is used when performing a full or partial-ring pet scan to determine the stage of breast cancer and to plan for surgical interventions, such as the staging of axillary lymph nodes.

2. Official Description

The official description of HCPCS code G0252 is “Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)”. The short description for this code is “Pet imaging initial dx”.

3. Procedure

1. The procedure for HCPCS code G0252 involves the use of pet scanners, specifically full and partial-ring pet scanners.
2. The pet imaging is performed to obtain detailed images of the breast area and axillary lymph nodes.
3. The images obtained from the pet scan are used for the initial diagnosis of breast cancer and/or surgical planning.
4. The pet scan helps in determining the stage of breast cancer and identifying any metastasis to the axillary lymph nodes.
5. The procedure is typically performed by a trained healthcare professional in a radiology department or imaging center.

4. When to use HCPCS code G0252

HCPCS code G0252 should be used when performing pet imaging for the initial diagnosis of breast cancer and/or surgical planning for breast cancer. It is specifically used for the initial staging of axillary lymph nodes. This code is not applicable for other types of cancer or for follow-up imaging.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0252, healthcare providers need to document the medical necessity of the procedure, including the reason for the initial diagnosis or surgical planning for breast cancer. They should also include the findings from the pet imaging and any relevant clinical information supporting the use of this code.

6. Historical Information and Code Maintenance

HCPCS code G0252 was added to the Healthcare Common Procedure Coding System on October 01, 2002. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G0252 is classified as non-covered by Medicare, indicated by the coverage code M. This means that Medicare does not provide reimbursement for this specific procedure. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service is either not covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which means that the value for this code is not established.

8. Examples

Here are five examples of when HCPCS code G0252 should be billed:

1. A patient presents with a suspicious breast lump, and a pet scan is performed to determine if the lump is cancerous and to plan for a biopsy.
2. A patient with a known diagnosis of breast cancer undergoes a pet scan to assess the extent of the disease and to plan for surgery.
3. A patient with breast cancer undergoes a pet scan to determine if there is any metastasis to the axillary lymph nodes.
4. A patient with a history of breast cancer undergoes a pet scan as part of routine surveillance to monitor for recurrence or metastasis.
5. A patient with a newly diagnosed breast cancer undergoes a pet scan to determine the stage of the disease and to plan for neoadjuvant therapy.