How To Use HCPCS Code G9053

HCPCS code G9053 describes the primary focus of a visit in oncology where expectant management is provided to a patient with evidence of cancer. This code is specifically used for patients who are not currently receiving or arranging for any cancer-directed therapy, but may consider it in the future. It is important to note that this code is only applicable for use in a Medicare-approved demonstration project.

1. What is HCPCS G9053?

HCPCS code G9053 is a specific code used in medical coding to identify and describe the expectant management of a patient with evidence of cancer. It signifies that no cancer-directed therapy is being administered or arranged at present, but it may be considered in the future. This code is used in a Medicare-approved demonstration project.

2. Official Description

The official description of HCPCS code G9053 is “Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered or arranged at present; cancer directed therapy might be considered in the future (for use in a Medicare-approved demonstration project).” The short description for this code is “Onc expectant management pt.”

3. Procedure

1. The provider begins by assessing the patient’s medical history and conducting a thorough physical examination.
2. If the patient has evidence of cancer, the provider determines that no cancer-directed therapy is currently being administered or arranged.
3. The provider discusses with the patient the option of expectant management, which involves closely monitoring the patient’s condition and considering cancer-directed therapy in the future if necessary.
4. During subsequent visits, the provider continues to monitor the patient’s condition, assess any changes or progression of the cancer, and discuss the potential need for cancer-directed therapy.

4. When to use HCPCS code G9053

HCPCS code G9053 should be used when a patient with evidence of cancer is receiving expectant management, meaning no cancer-directed therapy is being administered or arranged at present. This code is specifically used in a Medicare-approved demonstration project and may not be applicable in other contexts.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9053, healthcare providers need to document the patient’s evidence of cancer, the decision for expectant management, and any discussions regarding the potential need for cancer-directed therapy in the future. It is important to accurately document the medical necessity and appropriateness of using this code in the patient’s medical record.

6. Historical Information and Code Maintenance

HCPCS code G9053 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 G9053 is not payable by Medicare, as indicated by the coverage code I, which means it is not reimbursable. This code is not separately priced by Part B and is considered a service not covered or bundled. The pricing indicator code is 00, indicating that the service is not separately priced. The multiple pricing indicator code is 9, which means it is not applicable as the HCPCS code is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9053 should be billed:

1. A patient with evidence of cancer visits an oncologist for a routine check-up. The oncologist determines that no cancer-directed therapy is currently necessary and discusses the option of expectant management with the patient.
2. A patient with evidence of cancer undergoes a series of diagnostic tests. The results show no immediate need for cancer-directed therapy, but the patient will be closely monitored for any changes in their condition.
3. A patient with evidence of cancer consults with an oncology specialist to discuss treatment options. After a thorough evaluation, it is determined that expectant management is the most appropriate course of action at this time.
4. A patient with evidence of cancer receives regular follow-up visits with an oncologist. The oncologist continues to monitor the patient’s condition and discusses the potential need for cancer-directed therapy in the future if there are any signs of disease progression.
5. A patient with evidence of cancer participates in a Medicare-approved demonstration project focused on expectant management. The patient’s progress and response to expectant management are closely monitored and documented.