How To Use HCPCS Code G8877

HCPCS code G8877 describes a situation where the clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, and the reason for not doing so is not given. This code falls under the category of medical care and is not separately priced by Part B of the Healthcare Common Procedure Coding System (HCPCS). It was added to the system on January 1, 2012, with an effective date of January 1, 2013.

1. What is HCPCS G8877?

HCPCS code G8877 is used to indicate that the clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, and the reason for not doing so is not provided. This code is specific to breast cancer diagnosis and is used to capture instances where a clinician did not perform a minimally invasive biopsy procedure to confirm the presence of breast cancer before proceeding with surgery.

2. Official Description

The official description of HCPCS code G8877 is “Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given.” The short description for this code is “No breast cancer diagnosis by minimally invasive method.”

3. Procedure

1. The clinician evaluates the patient’s medical history and performs a physical examination to assess the presence of breast cancer symptoms.
2. If breast cancer is suspected based on the initial evaluation, the clinician may order additional diagnostic tests, such as mammography, ultrasound, or MRI.
3. Based on the results of the initial evaluation and diagnostic tests, the clinician determines whether a minimally invasive biopsy procedure is necessary to confirm the presence of breast cancer.
4. If the clinician decides not to perform a minimally invasive biopsy procedure, HCPCS code G8877 is used to indicate this decision.

4. When to use HCPCS code G8877

HCPCS code G8877 should be used when the clinician chooses not to attempt the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, and the reason for not doing so is not provided. This code is specific to breast cancer diagnosis and should only be used in cases where the clinician has made a deliberate decision not to perform a minimally invasive biopsy procedure.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G8877, healthcare providers should ensure that the medical record clearly documents the reason for not attempting the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method. This documentation should support the clinician’s decision and provide a clear rationale for not performing the procedure. Additionally, providers should follow the standard billing guidelines for submitting claims and ensure that all necessary documentation is included.

6. Historical Information and Code Maintenance

HCPCS code G8877 was added to the Healthcare Common Procedure Coding System on January 1, 2012. It has an effective date of January 1, 2013. As of now, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important to note that the absence of maintenance actions does not imply that the code is no longer valid or in use.

7. Medicare and Insurance Coverage

HCPCS code G8877 is covered by Medicare and other insurance providers. However, it is important to check with individual payers to determine their specific coverage policies and requirements. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value for pricing this code is not established.

8. Examples

Here are some examples of when HCPCS code G8877 should be billed:

1. A patient presents with a suspicious breast lump, and the clinician decides to proceed directly to surgery without performing a minimally invasive biopsy.
2. A patient with a family history of breast cancer undergoes a mammogram, which shows a suspicious mass. The clinician decides to proceed with surgery without performing a minimally invasive biopsy.
3. A patient with a known breast mass refuses to undergo a minimally invasive biopsy procedure. The clinician proceeds with surgery without attempting the diagnosis preoperatively.
4. A patient presents with symptoms consistent with breast cancer, but due to medical contraindications, the clinician decides not to perform a minimally invasive biopsy. Surgery is performed without attempting the diagnosis preoperatively.
5. A patient with a history of breast cancer recurrence undergoes imaging studies that suggest the presence of a new tumor. The clinician decides to proceed with surgery without performing a minimally invasive biopsy.