How To Use HCPCS Code G9139

HCPCS code G9139 describes the oncology disease status of chronic myelogenous leukemia (CML) that is limited to Philadelphia chromosome positive and/or BCR-ABL positive. This code is used when the extent of the disease is unknown and staging is in progress. It is specifically designated for use in a Medicare-approved demonstration project.

1. What is HCPCS G9139?

HCPCS code G9139 is a specific code used to identify the disease status of chronic myelogenous leukemia (CML) in cases where the extent of the disease is unknown and staging is still in progress. It is limited to Philadelphia chromosome positive and/or BCR-ABL positive cases. This code is used in a Medicare-approved demonstration project.

2. Official Description

The official description of HCPCS code G9139 is “Oncology; disease status; chronic myelogenous leukemia, limited to Philadelphia chromosome positive and/or BCR-ABL positive; extent of disease unknown, staging in progress, not listed (for use in a Medicare-approved demonstration project).” The short description is “Onc dx CML dx status unknown.”

3. Procedure

1. Perform a thorough evaluation of the patient’s medical history and symptoms.
2. Conduct necessary diagnostic tests to determine the presence of Philadelphia chromosome and/or BCR-ABL gene.
3. Assess the extent of the disease and stage the chronic myelogenous leukemia.
4. Document the disease status as unknown and indicate that staging is in progress.
5. Use HCPCS code G9139 to report the disease status of chronic myelogenous leukemia in the Medicare-approved demonstration project.

4. When to use HCPCS code G9139

HCPCS code G9139 should be used when documenting the disease status of chronic myelogenous leukemia (CML) that is limited to Philadelphia chromosome positive and/or BCR-ABL positive cases. It is specifically used when the extent of the disease is unknown and staging is in progress. This code is applicable only in a Medicare-approved demonstration project.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9139, healthcare providers need to ensure that the documentation clearly indicates the disease status as unknown and the ongoing staging process. It is important to provide detailed information about the patient’s medical history, diagnostic tests performed, and any other relevant findings. The documentation should also specify that the code is being used for a Medicare-approved demonstration project.

6. Historical Information and Code Maintenance

HCPCS code G9139 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 G9139 is determined by the carrier’s judgment (coverage code C). 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 is either 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.

8. Examples

Here are five examples of when HCPCS code G9139 should be billed:

1. A patient with chronic myelogenous leukemia (CML) is undergoing diagnostic tests to determine the extent of the disease. Staging is in progress, and the disease status is currently unknown. HCPCS code G9139 should be used to report this scenario in the Medicare-approved demonstration project.
2. A patient with Philadelphia chromosome positive and/or BCR-ABL positive CML is being evaluated for disease status. Staging is ongoing, and the extent of the disease is yet to be determined. HCPCS code G9139 is appropriate for reporting in this case.
3. In a Medicare-approved demonstration project, a patient with CML is undergoing diagnostic tests to assess the disease status. The extent of the disease is unknown, and staging is in progress. HCPCS code G9139 should be used to document this scenario.
4. A patient with CML is enrolled in a Medicare-approved demonstration project. The disease status is currently unknown, and staging is underway. HCPCS code G9139 is the appropriate code to report this situation.
5. In a Medicare-approved demonstration project, a patient with CML is being evaluated for disease status. The extent of the disease is not yet determined, and staging is in progress. HCPCS code G9139 should be used to document this case.