How To Use HCPCS Code G9052

HCPCS code G9052 describes the specific medical procedure for oncology patients who have completed definitive cancer-directed therapy and are currently being monitored for disease recurrence. This code is used in a Medicare-approved demonstration project and is not payable by Medicare. In this article, we will explore the details of HCPCS code G9052, 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 G9052?

HCPCS code G9052 is used to identify the medical service provided to oncology patients who have completed definitive cancer-directed therapy and are currently being monitored for disease recurrence. The primary focus of this visit is surveillance for disease recurrence, and cancer-directed therapy might be considered in the future. It is important to note that this code is only applicable for use in a Medicare-approved demonstration project and is not payable by Medicare.

2. Official Description

The official description of HCPCS code G9052 is as follows: “Oncology; primary focus of visit; surveillance for disease recurrence for patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease; cancer directed therapy might be considered in the future (for use in a Medicare-approved demonstration project).” The short description of this code is “Onc surveillance for disease.”

3. Procedure

1. The provider begins by reviewing the patient’s medical history and previous cancer-directed therapy.
2. A comprehensive physical examination is performed to assess the patient’s overall health and any potential signs of disease recurrence.
3. Laboratory tests, such as blood work or imaging studies, may be ordered to monitor for any changes or abnormalities.
4. The provider discusses the results of the surveillance tests with the patient and determines if further cancer-directed therapy is necessary.
5. If cancer-directed therapy is deemed necessary, the provider develops a treatment plan and discusses it with the patient.
6. Follow-up appointments are scheduled to monitor the patient’s progress and adjust the treatment plan as needed.

4. When to use HCPCS code G9052

HCPCS code G9052 should be used when the primary focus of the visit is surveillance for disease recurrence in an oncology patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease. This code is specifically intended for use in a Medicare-approved demonstration project and is not payable by Medicare.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9052, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the patient’s completion of definitive cancer-directed therapy
• Evidence that the patient currently lacks evidence of recurrent disease
• Documentation of the surveillance tests performed and their results
• Documentation of any discussions regarding potential future cancer-directed therapy

Providers should follow the appropriate billing guidelines and submit the claim with the necessary supporting documentation to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9052 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 G9052 is not payable by Medicare. It falls under the coverage code I, which means it is not payable by Medicare. The pricing indicator code for this code is 00, indicating that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9052 should be billed:

1. A patient who has completed definitive cancer-directed therapy for breast cancer and is currently being monitored for disease recurrence.
2. A patient who has completed definitive cancer-directed therapy for lung cancer and is undergoing regular surveillance tests to detect any signs of disease recurrence.
3. A patient who has completed definitive cancer-directed therapy for colon cancer and is scheduled for follow-up appointments to monitor for any potential recurrence.
4. A patient who has completed definitive cancer-directed therapy for prostate cancer and is undergoing regular PSA tests to monitor for any signs of disease recurrence.
5. A patient who has completed definitive cancer-directed therapy for ovarian cancer and is currently being monitored for any signs of disease recurrence through regular imaging studies.