How To Use HCPCS Code G9079

HCPCS code G9079 describes a specific oncology procedure for the disease status of prostate cancer. This code is limited to cases where the predominant cell type is adenocarcinoma and the cancer is classified as T3b-T4 with any N stage. Additionally, it can be used for cases where the cancer is any T stage with N1 at the time of diagnosis, and there is no evidence of disease progression, recurrence, or metastases. It is important to note that this code is specifically used in a Medicare-approved demonstration project.

1. What is HCPCS G9079?

HCPCS code G9079 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 the disease status of prostate cancer with specific criteria as mentioned earlier. This code helps healthcare providers and medical coders accurately document and bill for the services provided.

2. Official Description

The official description of HCPCS code G9079 is “Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; T3b-T4, any N; any T, N1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a Medicare-approved demonstration project).” The short description for this code is “Onc dx prostate T3b-T4noprog.”

3. Procedure

1. The procedure for HCPCS code G9079 involves assessing the disease status of prostate cancer based on specific criteria. This includes determining the predominant cell type as adenocarcinoma and the stage of the cancer.
2. For cases classified as T3b-T4 with any N stage, the provider should confirm the presence of these characteristics through appropriate diagnostic tests and imaging studies.
3. In cases where the cancer is any T stage with N1 at the time of diagnosis, the provider should ensure that there is no evidence of disease progression, recurrence, or metastases.
4. It is important for the provider to accurately document the disease status and meet the eligibility criteria for using HCPCS code G9079.

4. When to use HCPCS code G9079

HCPCS code G9079 should be used in specific contexts or conditions related to the disease status of prostate cancer. It is important to follow the guidelines and eligibility criteria for using this code. Providers should ensure that the patient’s condition meets the criteria mentioned in the official description, including the specific cell type, stage, and absence of disease progression, recurrence, or metastases.

5. Billing Guidelines and Documentation Requirements

When billing for services or procedures associated with HCPCS code G9079, healthcare providers need to ensure proper documentation. This includes documenting the disease status of prostate cancer, including the specific cell type, stage, and absence of disease progression, recurrence, or metastases. Providers should also include any relevant diagnostic tests or imaging studies that support the diagnosis and eligibility for using this code.

6. Historical Information and Code Maintenance

HCPCS code G9079 was added to the Healthcare Common Procedure Coding System on January 01, 2006. It has an effective date of January 01, 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 G9079 is covered by Medicare under a specific demonstration project. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This indicates that the service is bundled or not covered by Medicare. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS code G9079 is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9079 should be billed:

1. A patient is diagnosed with prostate cancer, and the biopsy confirms adenocarcinoma as the predominant cell type. The cancer is classified as T3b with no evidence of disease progression, recurrence, or metastases.
2. A patient is diagnosed with prostate cancer, and the biopsy confirms adenocarcinoma as the predominant cell type. The cancer is classified as T4 with no evidence of disease progression, recurrence, or metastases.
3. A patient is diagnosed with prostate cancer, and the biopsy confirms adenocarcinoma as the predominant cell type. The cancer is classified as any T stage with N1 at the time of diagnosis, and there is no evidence of disease progression, recurrence, or metastases.
4. A patient is diagnosed with prostate cancer, and the biopsy confirms adenocarcinoma as the predominant cell type. The cancer is classified as T3b-T4 with any N stage, and there is no evidence of disease progression, recurrence, or metastases.
5. A patient is diagnosed with prostate cancer, and the biopsy confirms adenocarcinoma as the predominant cell type. The cancer is classified as any T stage with N1 at the time of diagnosis, and there is no evidence of disease progression, recurrence, or metastases.