How To Use HCPCS Code G9115

HCPCS code G9115 describes the oncology disease status of ovarian cancer, specifically limited to epithelial cancer, at pathologic stage III-IV, without evidence of progression, recurrence, or metastases. This code is used in a Medicare-approved demonstration project.

1. What is HCPCS G9115?

HCPCS code G9115 is a specific code used to identify the disease status of ovarian cancer. It is specifically used for cases where the cancer is limited to epithelial cancer and is at pathologic stage III-IV. This code is only applicable when there is no evidence of progression, recurrence, or metastases. It is important to note that this code is used in a Medicare-approved demonstration project.

2. Official Description

The official description of HCPCS code G9115 is “Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage III-IV; without evidence of progression, recurrence, or metastases (for use in a Medicare-approved demonstration project).” The short description of this code is “Onc dx ovarian stg3/4 noprog.”

3. Procedure

1. Perform a thorough evaluation of the patient’s medical history and current condition.
2. Confirm the diagnosis of ovarian cancer limited to epithelial cancer at pathologic stage III-IV.
3. Ensure that there is no evidence of progression, recurrence, or metastases.
4. Document all relevant findings and medical records.
5. Assign HCPCS code G9115 to accurately represent the disease status of the patient’s ovarian cancer.

4. When to use HCPCS code G9115

HCPCS code G9115 should be used when documenting the disease status of ovarian cancer in patients. It is specifically applicable for cases where the cancer is limited to epithelial cancer and is at pathologic stage III-IV. Additionally, there should be no evidence of progression, recurrence, or metastases. It is important to note that this code is used in a Medicare-approved demonstration project, so it may have specific eligibility criteria or guidelines for use.

5. Billing Guidelines and Documentation Requirements

When billing for services or supplies associated with HCPCS code G9115, healthcare providers need to ensure proper documentation. This includes documenting the patient’s diagnosis of ovarian cancer limited to epithelial cancer at pathologic stage III-IV, as well as confirming the absence of progression, recurrence, or metastases. Providers should also include any relevant medical records and findings to support the use of this code.

6. Historical Information and Code Maintenance

HCPCS code G9115 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 used in a Medicare-approved demonstration project, which may have specific requirements or guidelines for its use.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G9115 by Medicare and other insurance providers may vary. The pricing indicator code for this code is 00, which means 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 it is not applicable as HCPCS is not priced separately by Part B or the value is not established. It is important to check with Medicare or the specific insurance provider for information on coverage and reimbursement.

8. Examples

Here are five examples of when HCPCS code G9115 should be billed:

1. A patient with ovarian cancer limited to epithelial cancer at pathologic stage III, without evidence of progression, recurrence, or metastases.
2. A patient with ovarian cancer limited to epithelial cancer at pathologic stage IV, without evidence of progression, recurrence, or metastases.
3. A patient with a previous diagnosis of ovarian cancer limited to epithelial cancer at pathologic stage III, without evidence of progression, recurrence, or metastases, who is undergoing follow-up treatment.
4. A patient participating in a Medicare-approved demonstration project for the management of ovarian cancer limited to epithelial cancer at pathologic stage III-IV, without evidence of progression, recurrence, or metastases.
5. A patient with a history of ovarian cancer limited to epithelial cancer at pathologic stage III-IV, without evidence of progression, recurrence, or metastases, who requires ongoing monitoring and management.