How To Use HCPCS Code G9066

HCPCS code G9066 describes a specific oncology procedure related to the disease status of non-small cell lung cancer. This code is limited to patients with stage III B-IV at diagnosis, including those with metastatic, locally recurrent, or progressive cancer. It is important to note that this code is specifically used in a Medicare-approved demonstration project.

1. What is HCPCS G9066?

HCPCS code G9066 is a unique alphanumeric code that is used to identify a specific procedure or service in the Healthcare Common Procedure Coding System. In this case, it is used to describe an oncology procedure related to the disease status of non-small cell lung cancer.

2. Official Description

The official description of HCPCS code G9066 is “Oncology; disease status; limited to non-small cell lung cancer; stage III B-IV at diagnosis, metastatic, locally recurrent, or progressive (for use in a Medicare-approved demonstration project).” The short description of this code is “Onc dx nsclc stg3b-4 metasta.”

3. Procedure

1. Patients who meet the eligibility criteria for the Medicare-approved demonstration project will undergo a comprehensive evaluation to determine the disease status of their non-small cell lung cancer.
2. The healthcare provider will assess the stage of the cancer at the time of diagnosis, considering factors such as tumor size, lymph node involvement, and the presence of metastasis.
3. If the patient is diagnosed with stage III B-IV non-small cell lung cancer and meets the other specified criteria, the provider will proceed with the designated oncology procedure.
4. The specific details of the procedure will vary depending on the individual patient’s condition and treatment plan.
5. It is important for healthcare providers to accurately document the procedure and any relevant details in the patient’s medical records.

4. When to use HCPCS code G9066

HCPCS code G9066 should be used when providing oncology services to patients with non-small cell lung cancer who meet the specified disease status criteria. This code is limited to patients with stage III B-IV at diagnosis, including those with metastatic, locally recurrent, or progressive cancer. It is important to note that this code is only applicable in the context of a Medicare-approved demonstration project.

5. Billing Guidelines and Documentation Requirements

When billing for services or procedures using HCPCS code G9066, healthcare providers should ensure that they meet all necessary documentation requirements. This includes accurately documenting the patient’s disease status, stage of cancer, and any other relevant details in the medical records. Additionally, providers should follow the appropriate billing guidelines and submit the claim with the correct coding information to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9066 was added to the Healthcare Common Procedure Coding System on January 01, 2006. It has an effective date of January 01, 2007. As of the provided information, 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 G9066 is eligible for coverage by Medicare. The pricing indicator code for this code is 00, which indicates 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 that it is not applicable as HCPCS is not priced separately by Part B or the value is not established. It is important for healthcare providers to verify coverage and reimbursement policies with Medicare and other insurance providers.

8. Examples

Here are five examples of scenarios where HCPCS code G9066 may be used:

1. A patient with non-small cell lung cancer is diagnosed with stage III B-IV disease and has evidence of metastasis. The patient is enrolled in a Medicare-approved demonstration project, and the designated oncology procedure is performed.
2. A patient with locally recurrent non-small cell lung cancer is determined to have stage III B-IV disease. The patient meets the eligibility criteria for the Medicare-approved demonstration project and undergoes the specified oncology procedure.
3. A patient with non-small cell lung cancer is initially diagnosed with stage III B-IV disease. Over time, the cancer progresses, and the patient becomes eligible for the Medicare-approved demonstration project. The designated oncology procedure is performed.
4. A patient with non-small cell lung cancer is diagnosed with stage III B-IV disease and undergoes treatment. After a period of remission, the cancer recurs locally. The patient meets the criteria for the Medicare-approved demonstration project and receives the specified oncology procedure.
5. A patient with non-small cell lung cancer is initially diagnosed with stage III B-IV disease and undergoes treatment. Despite treatment, the cancer progresses, and the patient becomes eligible for the Medicare-approved demonstration project. The designated oncology procedure is performed.