How To Use HCPCS Code G8723

HCPCS code G8723 describes a situation where the specimen site is other than the anatomic location of the primary tumor. This code is used to indicate that the sample taken for testing or analysis is from a different site than where the primary tumor is located. It is important for medical coders to understand the meaning and usage of this code to ensure accurate documentation and billing.

1. What is HCPCS G8723?

HCPCS code G8723 is used to identify cases where the specimen site is different from the anatomic location of the primary tumor. This code is specific to situations where the sample taken for testing or analysis is from a site other than where the primary tumor is located. It is important to note that this code is not used to indicate the primary tumor site itself, but rather the site from which the specimen was obtained.

2. Official Description

The official description of HCPCS code G8723 is “Specimen site is other than anatomic location of primary tumor.” The short description for this code is “Spec sit not prim tumor.” This description accurately reflects the purpose of the code, which is to indicate that the specimen site differs from the anatomic location of the primary tumor.

3. Procedure

1. When documenting and coding for HCPCS code G8723, the medical provider should clearly indicate the anatomic location of the primary tumor and the site from which the specimen was obtained.
2. The provider should document the specific procedure or method used to obtain the specimen, as well as any relevant details regarding the procedure.
3. It is important to ensure that the documentation accurately reflects the relationship between the specimen site and the primary tumor site.
4. Medical coders should review the medical record and extract the necessary information to assign HCPCS code G8723.

4. When to use HCPCS code G8723

HCPCS code G8723 should be used in cases where the specimen site is different from the anatomic location of the primary tumor. This code is specific to situations where the sample taken for testing or analysis is from a site other than where the primary tumor is located. It is important to accurately identify and document this distinction to ensure proper coding and billing.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8723, healthcare providers should ensure that the medical record includes the following documentation:

• Anatomic location of the primary tumor
• Site from which the specimen was obtained
• Procedure or method used to obtain the specimen
• Any relevant details regarding the procedure

By including this information in the medical record, providers can accurately code and bill for HCPCS code G8723.

6. Historical Information and Code Maintenance

HCPCS code G8723 was added to the Healthcare Common Procedure Coding System on January 01, 2012. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has a pricing indicator code of 00, which indicates that the service is not separately priced by Part B. It is important for medical coders to stay updated on any changes or revisions to HCPCS codes to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

Medicare and other insurance coverage for HCPCS code G8723 may vary. It is important for healthcare providers to review the specific guidelines and policies of each payer to determine coverage and reimbursement. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value is not established or applicable as HCPCS code G8723 is not priced separately by Part B.

8. Examples

Here are some examples of when HCPCS code G8723 should be billed:

1. A patient has a primary tumor in the lung, but the specimen for testing is obtained from a lymph node in the neck.
2. A patient has a primary tumor in the colon, but the specimen for testing is obtained from a liver metastasis.
3. A patient has a primary tumor in the breast, but the specimen for testing is obtained from a bone metastasis.
4. A patient has a primary tumor in the prostate, but the specimen for testing is obtained from a lymph node in the pelvis.
5. A patient has a primary tumor in the skin, but the specimen for testing is obtained from a lymph node in the groin.