How To Use HCPCS Code G9117

HCPCS code G9117 describes a specific oncology service related to ovarian cancer. This code is used to identify the disease status of ovarian cancer when the extent of the disease is unknown, staging is in progress, or not listed. It is important for medical coders to understand the meaning and usage of this code to accurately document and bill for the services provided.

1. What is HCPCS G9117?

HCPCS code G9117 is a specific code used in the Healthcare Common Procedure Coding System to identify and classify medical procedures and services. In this case, G9117 is used to describe the disease status of ovarian cancer when the extent of the disease is unknown, staging is in progress, or not listed. This code is specifically used in a Medicare-approved demonstration project.

2. Official Description

The official description of HCPCS code G9117 is “Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent of disease unknown, staging in progress, or not listed (for use in a Medicare-approved demonstration project)”. The short description for this code is “Onc dx ovarian unknown nos”.

3. Procedure

1. When using HCPCS code G9117, the healthcare provider should first assess the disease status of the patient’s ovarian cancer.
2. If the extent of the disease is unknown, further diagnostic tests and evaluations may be necessary to determine the stage and severity of the cancer.
3. If staging is in progress, the provider should document the ongoing process of determining the stage of the ovarian cancer.
4. If the stage of the cancer is not listed, the provider should document the specific reason why the stage is not available or documented.
5. It is important for the provider to accurately document the disease status of the ovarian cancer to ensure proper coding and billing.

4. When to use HCPCS code G9117

HCPCS code G9117 should be used in the context of ovarian cancer when the extent of the disease is unknown, staging is in progress, or the stage is not listed. This code is specifically used in a Medicare-approved demonstration project, so it may have specific eligibility criteria or guidelines for use. Medical coders should refer to the project guidelines and documentation requirements to ensure accurate usage of this code.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9117, healthcare providers need to ensure proper documentation of the disease status of the ovarian cancer. This includes documenting the specific reason for unknown extent, ongoing staging process, or lack of stage information. Additionally, providers should follow the billing guidelines and requirements set forth by the Medicare-approved demonstration project to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9117 was added to the Healthcare Common Procedure Coding System on January 01, 2006. As of the effective date of January 01, 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. It is important for medical coders to stay updated on any changes or revisions to this code in the future.

7. Medicare and Insurance Coverage

HCPCS code G9117 is covered by Medicare as part of 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. This indicates that the service may be bundled or not covered by Medicare. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS G9117 is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9117 should be billed:

1. A patient with ovarian cancer undergoes initial diagnostic tests to determine the extent of the disease, but the results are inconclusive. HCPCS code G9117 should be used to indicate the unknown extent of the disease.
2. A patient with ovarian cancer is in the process of staging, and the provider documents the ongoing evaluations and tests being conducted. HCPCS code G9117 should be used to indicate the staging in progress.
3. A patient with ovarian cancer has no documented stage due to incomplete medical records or lack of information. HCPCS code G9117 should be used to indicate the lack of stage information.
4. A patient with ovarian cancer is enrolled in a Medicare-approved demonstration project, and the disease status is unknown. HCPCS code G9117 should be used to indicate the unknown disease status in the context of the project.
5. A patient with ovarian cancer is enrolled in a Medicare-approved demonstration project, and the stage of the cancer is not listed. HCPCS code G9117 should be used to indicate the lack of stage information in the context of the project.