How To Use HCPCS Code G9105

HCPCS code G9105 describes the specific medical procedure for oncology disease status in patients with pancreatic cancer. This code is used to identify cases where the patient has undergone a post R0 resection without 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 G9105?

HCPCS code G9105 is a specific code used to identify the disease status of pancreatic cancer in patients who have undergone a post R0 resection without any evidence of disease progression, recurrence, or metastases. This code is used in a Medicare-approved demonstration project and is not applicable for general use.

2. Official Description

The official description of HCPCS code G9105 is “Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post R0 resection without evidence of disease progression, recurrence, or metastases (for use in a Medicare-approved demonstration project).” The short description of this code is “Onc dx pancreatc p r0 res no.”

3. Procedure

1. The procedure for HCPCS code G9105 involves assessing the disease status of pancreatic cancer in patients who have undergone a post R0 resection.
2. The healthcare provider will review the patient’s medical records and diagnostic tests to determine if there is any evidence of disease progression, recurrence, or metastases.
3. If there is no evidence of disease progression, recurrence, or metastases, the provider will assign HCPCS code G9105 to indicate the disease status of pancreatic cancer.

4. When to use HCPCS code G9105

HCPCS code G9105 should be used in cases where the patient has undergone a post R0 resection for pancreatic cancer and there is no evidence of disease progression, recurrence, or metastases. This code is specifically used in a Medicare-approved demonstration project and may not be applicable for general use.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9105, healthcare providers need to document the patient’s medical records and diagnostic tests to support the use of this code. The documentation should clearly indicate that the patient has undergone a post R0 resection for pancreatic cancer and there is no evidence of disease progression, recurrence, or metastases. This documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9105 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. This code is specific to a Medicare-approved demonstration project and may not have significant historical changes or updates.

7. Medicare and Insurance Coverage

HCPCS code G9105 is payable by Medicare as it is used in a Medicare-approved demonstration project. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that it is not applicable as HCPCS G9105 is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9105 should be billed:

1. Example 1: A patient with pancreatic cancer undergoes a successful post R0 resection, and there is no evidence of disease progression, recurrence, or metastases. HCPCS code G9105 is used to indicate the disease status in this case.
2. Example 2: Another patient with pancreatic cancer undergoes a post R0 resection, and subsequent diagnostic tests show no evidence of disease progression, recurrence, or metastases. HCPCS code G9105 is assigned to indicate the disease status.
3. Example 3: A third patient with pancreatic cancer undergoes a post R0 resection, and follow-up examinations reveal no evidence of disease progression, recurrence, or metastases. HCPCS code G9105 is used to document the disease status.
4. Example 4: A patient participates in a Medicare-approved demonstration project for pancreatic cancer treatment. After a successful post R0 resection, there is no evidence of disease progression, recurrence, or metastases. HCPCS code G9105 is billed to indicate the disease status.
5. Example 5: In a clinical trial for pancreatic cancer, a patient undergoes a post R0 resection, and subsequent evaluations show no evidence of disease progression, recurrence, or metastases. HCPCS code G9105 is used to indicate the disease status in this trial.