How To Use HCPCS Code G9077

HCPCS code G9077 describes a specific oncology disease status for prostate cancer. This code is used to identify cases where the prostate cancer is limited to adenocarcinoma as the predominant cell type, with a tumor stage of T1-T2c and a Gleason score of 2-7. Additionally, the prostate-specific antigen (PSA) level at the time of diagnosis should be less than or equal to 20, and there should be no evidence of disease progression, recurrence, or metastases. It is important to note that this code is specifically designated for use in a Medicare-approved demonstration project.

1. What is HCPCS G9077?

HCPCS code G9077 is a unique alphanumeric code that is part of the Healthcare Common Procedure Coding System (HCPCS). It is used to identify a specific disease status for prostate cancer in a Medicare-approved demonstration project. This code provides detailed information about the characteristics of the prostate cancer, including the cell type, tumor stage, Gleason score, PSA level, and absence of disease progression, recurrence, or metastases.

2. Official Description

The official description of HCPCS code G9077 is as follows: “Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a Medicare-approved demonstration project)." The short description of this code is "Onc dx prostate t1no progres."

3. Procedure

1. Perform a thorough evaluation of the patient’s medical history, including previous diagnostic tests and imaging results.
2. Confirm the diagnosis of prostate cancer based on the specific criteria outlined in the code description.
3. Assess the tumor stage, Gleason score, and PSA level at the time of diagnosis.
4. Ensure that there is no evidence of disease progression, recurrence, or metastases.
5. Document all relevant findings and submit the appropriate claims using HCPCS code G9077.

4. When to use HCPCS code G9077

HCPCS code G9077 should be used in the context of a Medicare-approved demonstration project for prostate cancer. It is specifically intended for cases where the prostate cancer meets the specified criteria, including limited adenocarcinoma as the predominant cell type, tumor stage T1-T2c, Gleason score 2-7, PSA level ≤ 20 at diagnosis, and no evidence of disease progression, recurrence, or metastases. It is important to review the specific guidelines and eligibility criteria of the demonstration project to ensure proper use of this code.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies associated with HCPCS code G9077, healthcare providers should ensure accurate and detailed documentation. This documentation should include the patient’s medical history, diagnostic test results, tumor stage, Gleason score, PSA level, and evidence of disease progression, recurrence, or metastases. It is important to follow the specific billing guidelines and requirements of the Medicare-approved demonstration project to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9077 was added to the Healthcare Common Procedure Coding System on January 1, 2006. It has an effective date of January 1, 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

The coverage of HCPCS code G9077 is subject to the specific guidelines and policies of the Medicare-approved demonstration project. It is important to review the coverage criteria and requirements to determine if the services or supplies associated with this code are payable by Medicare. The pricing indicator code for this code is 00, which indicates 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 scenarios where HCPCS code G9077 may be used:

1. A patient with prostate cancer diagnosed with limited adenocarcinoma as the predominant cell type, tumor stage T1, Gleason score 6, PSA level of 15 at diagnosis, and no evidence of disease progression, recurrence, or metastases.
2. A patient with prostate cancer diagnosed with limited adenocarcinoma as the predominant cell type, tumor stage T2b, Gleason score 7, PSA level of 18 at diagnosis, and no evidence of disease progression, recurrence, or metastases.
3. A patient with prostate cancer diagnosed with limited adenocarcinoma as the predominant cell type, tumor stage T2c, Gleason score 5, PSA level of 10 at diagnosis, and no evidence of disease progression, recurrence, or metastases.
4. A patient with prostate cancer diagnosed with limited adenocarcinoma as the predominant cell type, tumor stage T1c, Gleason score 4, PSA level of 12 at diagnosis, and no evidence of disease progression, recurrence, or metastases.
5. A patient with prostate cancer diagnosed with limited adenocarcinoma as the predominant cell type, tumor stage T2a, Gleason score 3, PSA level of 8 at diagnosis, and no evidence of disease progression, recurrence, or metastases.