How To Use HCPCS Code G0464

HCPCS code G0464 describes a specific type of colorectal cancer screening procedure that involves the analysis of stool-based DNA and fecal occult hemoglobin. This code is used to identify and bill for the service provided by healthcare providers. In this article, we will explore the details of HCPCS code G0464, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0464?

HCPCS code G0464 is a specific code used to identify the procedure of colorectal cancer screening using stool-based DNA and fecal occult hemoglobin. This code is essential for medical coders and billers to accurately document and bill for this particular service.

2. Official Description

The official description of HCPCS code G0464 is “Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3).” The short description for this code is “Colorec ca scr, sto bas dna.”

3. Procedure

1. The healthcare provider collects a stool sample from the patient.
2. The stool sample is then analyzed in a laboratory using advanced techniques to detect the presence of DNA markers and fecal occult hemoglobin.
3. The results of the analysis are interpreted by the healthcare provider to determine if there are any indications of colorectal cancer.
4. If abnormalities or potential signs of colorectal cancer are found, further diagnostic tests or procedures may be recommended.

4. When to use HCPCS code G0464

HCPCS code G0464 should be used when healthcare providers perform a stool-based DNA and fecal occult hemoglobin test specifically for colorectal cancer screening purposes. It is important to ensure that the test is performed for this specific purpose and not for other diagnostic or monitoring purposes.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0464, healthcare providers need to document the following:

• The patient’s medical history and relevant risk factors for colorectal cancer.
• The date the test was performed.
• The results of the stool-based DNA and fecal occult hemoglobin analysis.
• Any additional diagnostic tests or procedures recommended based on the results.

Providers should also ensure that the documentation supports the medical necessity of the test for colorectal cancer screening.

6. Historical Information and Code Maintenance

HCPCS code G0464 was added to the Healthcare Common Procedure Coding System on October 09, 2014. It has an effective date of January 01, 2016. This code has a coverage code of C, which indicates that carrier judgment is used to determine coverage. The code has no maintenance actions, as indicated by the action code N.

7. Medicare and Insurance Coverage

HCPCS code G0464 is subject to the national limitation amount, as indicated by the pricing indicator code 21. The multiple pricing indicator code A indicates that the code is not applicable as HCPCS priced under one methodology. Medicare and other insurance providers may cover this procedure for eligible individuals, but coverage may vary depending on specific guidelines and policies.

8. Examples

Here are five examples of when HCPCS code G0464 should be billed:

1. A 50-year-old patient with a family history of colorectal cancer undergoes a stool-based DNA and fecal occult hemoglobin test as part of routine screening.
2. A 60-year-old patient with symptoms suggestive of colorectal cancer undergoes a stool-based DNA and fecal occult hemoglobin test to aid in the diagnosis.
3. A 45-year-old patient with a personal history of colorectal polyps undergoes a stool-based DNA and fecal occult hemoglobin test for surveillance purposes.
4. A 55-year-old patient with a positive result from a previous stool-based DNA and fecal occult hemoglobin test undergoes a repeat test to monitor for any changes.
5. A 70-year-old patient with a history of colorectal cancer undergoes a stool-based DNA and fecal occult hemoglobin test as part of post-treatment surveillance.