How To Use HCPCS Code G9133

HCPCS code G9133 describes a specific oncology procedure related to prostate cancer. In this article, we will delve into the details of this code, 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 G9133?

HCPCS code G9133 is used to identify a specific oncology procedure related to prostate cancer. It specifically refers to the disease status of prostate cancer, limited to adenocarcinoma, that is hormone-responsive and has clinical metastases or m1 at diagnosis. It is important to note that this code is intended for use in a Medicare-approved demonstration project.

2. Official Description

The official description of HCPCS code G9133 is “Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a Medicare-approved demonstration project).” The short description of this code is “Onc dx prostate clinical met.”

3. Procedure

1. Explain the how the provider would do procedure of HCPCS G9133 step by step with a lot of details.

4. When to use HCPCS code G9133

HCPCS code G9133 should be used in the context of prostate cancer cases where the disease is limited to adenocarcinoma, is hormone-responsive, and has clinical metastases or m1 at the time of diagnosis. It is important to note that this code is specifically designated for use in a Medicare-approved demonstration project.

5. Billing Guidelines and Documentation Requirements

Healthcare providers need to ensure proper documentation when billing for HCPCS code G9133. They should include detailed information about the patient’s prostate cancer diagnosis, including the disease status, hormone responsiveness, and clinical metastases or m1 at diagnosis. Additionally, providers should clearly indicate that the code is being used for a Medicare-approved demonstration project.

6. Historical Information and Code Maintenance

HCPCS code G9133 was added to the Healthcare Common Procedure Coding System on January 01, 2007. 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.

7. Medicare and Insurance Coverage

Medicare coverage for HCPCS code G9133 is determined by the carrier’s judgment, as indicated by the coverage code C. It is important to consult with Medicare or other insurance providers to determine the specific coverage and reimbursement policies for this code. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the code is not applicable for separate pricing by Part B.

8. Examples

Here are five examples of when HCPCS code G9133 should be billed:

1. Example 1: A 65-year-old male patient is diagnosed with prostate cancer. The disease is limited to adenocarcinoma, is hormone-responsive, and has clinical metastases at the time of diagnosis. The patient is enrolled in a Medicare-approved demonstration project, and the provider performs the necessary oncology procedures related to the disease status. HCPCS code G9133 should be billed for this case.
2. Example 2: A 70-year-old male patient is diagnosed with prostate cancer. The disease is limited to adenocarcinoma, is hormone-responsive, and has m1 at the time of diagnosis. The patient is not enrolled in a Medicare-approved demonstration project. In this case, HCPCS code G9133 should not be billed.
3. Example 3: A 60-year-old male patient is diagnosed with prostate cancer. The disease is limited to adenocarcinoma, is hormone-responsive, and has clinical metastases at the time of diagnosis. The patient is enrolled in a Medicare-approved demonstration project, but the provider does not perform any oncology procedures related to the disease status. In this case, HCPCS code G9133 should not be billed.
4. Example 4: A 55-year-old male patient is diagnosed with prostate cancer. The disease is not limited to adenocarcinoma or hormone-responsive, and there are no clinical metastases at the time of diagnosis. The patient is enrolled in a Medicare-approved demonstration project. In this case, HCPCS code G9133 should not be billed.
5. Example 5: A 75-year-old male patient is diagnosed with prostate cancer. The disease is limited to adenocarcinoma, is hormone-responsive, and has clinical metastases at the time of diagnosis. The patient is enrolled in a Medicare-approved demonstration project, but the provider performs oncology procedures unrelated to the disease status. HCPCS code G9133 should not be billed in this case.