How To Use HCPCS Code G9106

HCPCS code G9106 describes the oncology disease status for pancreatic cancer, specifically limited to adenocarcinoma. This code is used for patients who have undergone a post r1 or r2 resection with no evidence of disease progression or metastases. It is important to note that this code is specifically for use in a Medicare-approved demonstration project.

1. What is HCPCS G9106?

HCPCS code G9106 is a specific code used to identify the disease status of pancreatic cancer in patients who have undergone a post r1 or r2 resection. It is limited to adenocarcinoma and is used in a Medicare-approved demonstration project.

2. Official Description

The official description of HCPCS code G9106 is “Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 or r2 resection with no evidence of disease progression, or metastases (for use in a Medicare-approved demonstration project).” The short description is “Onc dx pancreatc p r1/r2 no.”

3. Procedure

1. Patients who have undergone a post r1 or r2 resection for pancreatic cancer are eligible for this code.
2. The provider must ensure that there is no evidence of disease progression or metastases.
3. The code should only be used for patients participating in a Medicare-approved demonstration project.

4. When to use HCPCS code G9106

HCPCS code G9106 should be used when documenting the disease status of pancreatic cancer in patients who have undergone a post r1 or r2 resection. It is important to ensure that there is no evidence of disease progression or metastases. Additionally, this code should only be used for patients participating in a Medicare-approved demonstration project.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9106, healthcare providers must ensure that the documentation clearly indicates the disease status of pancreatic cancer in the patient. It should be clearly stated that the patient has undergone a post r1 or r2 resection with no evidence of disease progression or metastases. Additionally, documentation should indicate that the patient is participating in a Medicare-approved demonstration project.

6. Historical Information and Code Maintenance

HCPCS code G9106 was added to the Healthcare Common Procedure Coding System on January 1, 2006. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. The code has an effective date of January 1, 2007. It is important to note that this code is specific to a Medicare-approved demonstration project.

7. Medicare and Insurance Coverage

HCPCS code G9106 is covered by Medicare. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. It is important to check with other insurers to determine their coverage and pricing policies for this specific code.

8. Examples

Here are five examples of when HCPCS code G9106 should be billed:

1. A patient with pancreatic cancer undergoes a post r1 resection and there is no evidence of disease progression or metastases. The patient is participating in a Medicare-approved demonstration project.
2. A patient with adenocarcinoma of the pancreas undergoes a post r2 resection and there is no evidence of disease progression or metastases. The patient is participating in a Medicare-approved demonstration project.
3. A patient with pancreatic cancer undergoes a post r1 resection and there is no evidence of disease progression or metastases. The patient is not participating in a Medicare-approved demonstration project.
4. A patient with adenocarcinoma of the pancreas undergoes a post r2 resection and there is evidence of disease progression. The patient is participating in a Medicare-approved demonstration project.
5. A patient with pancreatic cancer undergoes a post r1 resection and there is evidence of metastases. The patient is participating in a Medicare-approved demonstration project.