How To Use HCPCS Code G9051

HCPCS code G9051 describes a specific oncology treatment decision-making process after the disease has been staged or restaged. This code is used for the discussion of treatment options, supervision and coordination of active cancer-directed therapy, as well as managing the consequences of cancer-directed therapy. It is important to note that this code is specifically used in a Medicare-approved demonstration project and is not payable by Medicare.

1. What is HCPCS G9051?

HCPCS code G9051 is a specific code used to identify the primary focus of an oncology visit. It is used to indicate the treatment decision-making process after the disease has been staged or restaged. This code is used for the discussion of treatment options, supervision and coordination of active cancer-directed therapy, as well as managing the consequences of cancer-directed therapy.

2. Official Description

The official description of HCPCS code G9051 is “Oncology; primary focus of visit; treatment decision-making after disease is staged or restaged, discussion of treatment options, supervising/coordinating active cancer directed therapy or managing consequences of cancer directed therapy (for use in a Medicare-approved demonstration project).” The short description of this code is “Oncology tx decision-mgmt.”

3. Procedure

1. The provider begins by staging or restaging the disease to determine the appropriate treatment options.
2. Once the disease has been staged or restaged, the provider engages in a discussion with the patient regarding the available treatment options.
3. The provider supervises and coordinates the active cancer-directed therapy, ensuring that the chosen treatment plan is implemented effectively.
4. If the patient has already undergone cancer-directed therapy, the provider manages the consequences of the therapy, addressing any side effects or complications that may arise.

4. When to use HCPCS code G9051

HCPCS code G9051 should be used in the context of oncology visits where the primary focus is on treatment decision-making after the disease has been staged or restaged. This code is specifically used in a Medicare-approved demonstration project and may not be applicable in other settings.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9051, healthcare providers need to ensure that the documentation clearly reflects the primary focus of the visit, which is the treatment decision-making process after disease staging or restaging. The documentation should also include details of the discussion on treatment options, supervision and coordination of active cancer-directed therapy, or management of the consequences of cancer-directed therapy.

6. Historical Information and Code Maintenance

HCPCS code G9051 was added to the Healthcare Common Procedure Coding System on January 1, 2006. It has an effective date of January 1, 2007. 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 G9051 is not payable by Medicare. It falls under the coverage code I, which means it is not reimbursable by Medicare. The pricing indicator code for this code is 00, indicating 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 it is not applicable as HCPCS G9051 is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9051 should be billed:

1. A patient with stage III breast cancer visits an oncologist to discuss treatment options after the disease has been restaged.
2. A patient with lung cancer undergoes chemotherapy and requires ongoing management of the side effects and complications of the treatment.
3. An oncology patient is referred to a radiation oncologist for a consultation to discuss the potential benefits and risks of radiation therapy.
4. A patient with prostate cancer visits an oncologist to discuss the various treatment options available, including surgery, radiation therapy, and hormone therapy.
5. A patient with colorectal cancer undergoes surgery and requires post-operative management and coordination of further treatment.