How To Use HCPCS Code G9103

HCPCS code G9103 describes the oncology disease status for gastric cancer, specifically limited to adenocarcinoma as the predominant cell type. This code is used to indicate the clinical or pathologic M1 status at the time of diagnosis, whether the cancer is metastatic, locally recurrent, or progressive. It is important to note that this code is specifically designated for use in a Medicare-approved demonstration project.

1. What is HCPCS G9103?

HCPCS code G9103 is a specific code used in medical coding to identify the disease status of gastric cancer. It is limited to cases where adenocarcinoma is the predominant cell type and the cancer is clinically or pathologically determined to be M1 at the time of diagnosis. This code is primarily used in a Medicare-approved demonstration project.

2. Official Description

The official description of HCPCS code G9103 is “Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic M1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a Medicare-approved demonstration project).” The short description for this code is “Onc dx gastric recurrent.”

3. Procedure

1. Perform a clinical or pathological evaluation to determine the disease status of gastric cancer.
2. Confirm that the cancer is limited to adenocarcinoma as the predominant cell type.
3. Evaluate whether the cancer is clinically or pathologically determined to be M1 at the time of diagnosis.
4. Determine if the cancer is metastatic, locally recurrent, or progressive.

4. When to use HCPCS code G9103

HCPCS code G9103 should be used in cases where the patient has been diagnosed with gastric cancer and meets the specific criteria outlined in the code description. This includes having adenocarcinoma as the predominant cell type and being clinically or pathologically determined to be M1 at the time of diagnosis. The cancer must also be metastatic, locally recurrent, or progressive. It is important to note that this code is intended for use in a Medicare-approved demonstration project.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies associated with HCPCS code G9103, healthcare providers should ensure that the necessary documentation is in place. This may include medical records, pathology reports, and any other relevant documentation that supports the use of this code. Providers should also follow the specific billing guidelines set forth by Medicare or other insurers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9103 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 G9103 is determined by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This could indicate that the service is 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 the coverage and reimbursement policies of Medicare and other insurers for this specific code.

8. Examples

Here are five examples of when HCPCS code G9103 should be billed:

1. A patient is diagnosed with gastric cancer, and the pathology report confirms adenocarcinoma as the predominant cell type. The cancer is determined to be M1 at the time of diagnosis and is locally recurrent.
2. A patient with a history of gastric cancer undergoes a clinical evaluation, which reveals adenocarcinoma as the predominant cell type. The cancer is determined to be M1 at the time of diagnosis and is metastatic.
3. A patient presents with symptoms of gastric cancer, and further evaluation confirms adenocarcinoma as the predominant cell type. The cancer is determined to be M1 at the time of diagnosis and is progressive.
4. A patient with a previous diagnosis of gastric cancer experiences a recurrence. The pathology report confirms adenocarcinoma as the predominant cell type. The cancer is determined to be M1 at the time of diagnosis and is locally recurrent.
5. A patient is diagnosed with gastric cancer, and the clinical evaluation reveals adenocarcinoma as the predominant cell type. The cancer is determined to be M1 at the time of diagnosis and is metastatic.