How To Use HCPCS Code G9129

HCPCS code G9129 describes a specific oncology disease status related to multiple myeloma, a type of cancer that affects plasma cells in the bone marrow. This code is limited to cases where the disease has progressed to stage II or higher and is used specifically in a Medicare-approved demonstration project. In this article, we will explore the details of HCPCS code G9129, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9129?

HCPCS code G9129 is a specific code used to identify the disease status of multiple myeloma, a type of cancer that affects plasma cells in the bone marrow. This code is limited to cases where the disease has progressed to stage II or higher and is used in a Medicare-approved demonstration project. It provides important information about the severity and progression of the disease for billing and documentation purposes.

2. Official Description

The official description of HCPCS code G9129 is “Oncology; disease status; limited to multiple myeloma, systemic disease; stage II or higher (for use in a Medicare-approved demonstration project).” The short description is “Onc dx mult myeloma stg2 hig.” This description clearly indicates that this code is specific to the disease status of multiple myeloma and is limited to cases where the disease has progressed to stage II or higher.

3. Procedure

1. Perform a thorough assessment of the patient’s medical history and current condition to determine the stage of multiple myeloma.
2. Confirm that the patient meets the eligibility criteria for the Medicare-approved demonstration project.
3. Document the disease status of multiple myeloma, specifying whether it is stage II or higher.
4. Assign HCPCS code G9129 to accurately represent the disease status of multiple myeloma in the billing and documentation.

4. When to use HCPCS code G9129

HCPCS code G9129 should be used when documenting and billing for cases of multiple myeloma where the disease has progressed to stage II or higher. It is important to ensure that the patient meets the eligibility criteria for the Medicare-approved demonstration project before using this code. This code should not be used for cases of multiple myeloma that are below stage II or for other types of cancer.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9129, healthcare providers need to document the disease status of multiple myeloma, specifying whether it is stage II or higher. This documentation should be supported by relevant medical records, test results, and clinical assessments. When billing for the service, providers should ensure that the code is accurately reported on the claim form along with any other relevant codes and modifiers as required by the payer.

6. Historical Information and Code Maintenance

HCPCS code G9129 was added to the Healthcare Common Procedure Coding System on January 01, 2006. Since its addition, 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 has an effective date of January 01, 2007, and has not been terminated or revised since its inclusion in the system.

7. Medicare and Insurance Coverage

Medicare coverage for HCPCS code G9129 is determined by the Medicare-approved demonstration project. Providers should verify the specific coverage guidelines and requirements with Medicare or the applicable insurance provider. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the code is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9129 should be billed:

1. A patient with multiple myeloma diagnosed at stage III receives treatment as part of a Medicare-approved demonstration project.
2. A patient with multiple myeloma diagnosed at stage II undergoes a bone marrow biopsy as part of a Medicare-approved demonstration project.
3. A patient with multiple myeloma diagnosed at stage IV receives chemotherapy as part of a Medicare-approved demonstration project.
4. A patient with multiple myeloma diagnosed at stage II undergoes radiation therapy as part of a Medicare-approved demonstration project.
5. A patient with multiple myeloma diagnosed at stage III undergoes a stem cell transplant as part of a Medicare-approved demonstration project.