How To Use HCPCS Code G9114

HCPCS code G9114 describes a specific oncology disease status related to ovarian cancer. This code is used to identify cases of ovarian cancer that are limited to epithelial cancer, specifically pathologic stage ia-b (grade 2-3), stage ic (all grades), or stage ii. It is important to note that this code should only be used when there is no evidence of disease progression, recurrence, or metastases. HCPCS code G9114 is primarily used in a Medicare-approved demonstration project.

1. What is HCPCS G9114?

HCPCS code G9114 is a specific code used in medical coding to identify the disease status of ovarian cancer. It is used to indicate cases of ovarian cancer that are limited to epithelial cancer and fall under pathologic stage ia-b (grade 2-3), stage ic (all grades), or stage ii. This code is specifically used in a Medicare-approved demonstration project.

2. Official Description

The official description of HCPCS code G9114 is “Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii; 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 ovarian stg1a-b or 2”.

3. Procedure

1. Perform a thorough evaluation of the patient’s medical history and current condition to determine the stage and grade of the ovarian cancer.
2. Confirm that the patient’s ovarian cancer falls under pathologic stage ia-b (grade 2-3), stage ic (all grades), or stage ii.
3. Ensure that there is no evidence of disease progression, recurrence, or metastases.
4. Document all relevant information in the patient’s medical record.
5. Assign HCPCS code G9114 to indicate the disease status of ovarian cancer in the billing or coding system.

4. When to use HCPCS code G9114

HCPCS code G9114 should be used when documenting cases of ovarian cancer that meet the specific criteria outlined in the official description. It is important to ensure that the cancer is limited to epithelial cancer and falls under pathologic stage ia-b (grade 2-3), stage ic (all grades), or stage ii. Additionally, there should be no evidence of disease progression, recurrence, or metastases. This code is primarily used in a Medicare-approved demonstration project.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies related to HCPCS code G9114, healthcare providers need to ensure that the patient’s medical record clearly documents the disease status of ovarian cancer. This includes confirming the stage and grade of the cancer, as well as noting the absence of disease progression, recurrence, or metastases. Proper documentation is essential for accurate billing and coding.

6. Historical Information and Code Maintenance

HCPCS code G9114 was added to the Healthcare Common Procedure Coding System on January 01, 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. It is important to note that this code is specific to a Medicare-approved demonstration project and may not be applicable in all healthcare settings.

7. Medicare and Insurance Coverage

HCPCS code G9114 is covered by Medicare under the carrier judgment coverage code C. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This code is not applicable for services that are not covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which indicates that the value for pricing this code is not established. It is important to check with individual insurance providers for coverage and reimbursement information.

8. Examples

Here are five examples of when HCPCS code G9114 should be billed:

1. A patient with ovarian cancer diagnosed as pathologic stage ia (grade 2) without evidence of disease progression, recurrence, or metastases.
2. A patient with ovarian cancer diagnosed as pathologic stage ib (grade 3) without evidence of disease progression, recurrence, or metastases.
3. A patient with ovarian cancer diagnosed as pathologic stage ic (grade 1) without evidence of disease progression, recurrence, or metastases.
4. A patient with ovarian cancer diagnosed as pathologic stage ii without evidence of disease progression, recurrence, or metastases.
5. A patient with ovarian cancer diagnosed as pathologic stage ic (grade 2) without evidence of disease progression, recurrence, or metastases.