How To Use HCPCS Code G9294

HCPCS code G9294 describes a pathology report that includes the patient category, a statement on thickness and ulceration, and for pt1, the mitotic rate. This code is used to identify and bill for the specific information provided in the pathology report. In this article, we will explore the details of HCPCS code G9294, 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 G9294?

HCPCS code G9294 is used to identify a pathology report that includes the patient category, a statement on thickness and ulceration, and for pt1, the mitotic rate. This code is specific to the information provided in the pathology report and should be used when billing for this service.

2. Official Description

The official description of HCPCS code G9294 is “Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate.” The short description is “Pt cat and thck on report.”

3. Procedure

1. The provider receives the pathology report from the laboratory.
2. The provider reviews the pathology report to ensure it includes the patient category, a statement on thickness and ulceration, and for pt1, the mitotic rate.
3. If the pathology report contains the required information, the provider assigns HCPCS code G9294 to the report.
4. The provider includes HCPCS code G9294 on the claim form when billing for the pathology report.

4. When to use HCPCS code G9294

HCPCS code G9294 should be used when the pathology report includes the patient category, a statement on thickness and ulceration, and for pt1, the mitotic rate. It is important to ensure that the pathology report meets these criteria before assigning this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9294, healthcare providers need to document the pathology report that includes the patient category, a statement on thickness and ulceration, and for pt1, the mitotic rate. This documentation should be included in the patient’s medical record and submitted along with the claim form.

6. Historical Information and Code Maintenance

HCPCS code G9294 was added to the Healthcare Common Procedure Coding System on January 01, 2014. 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

HCPCS code G9294 may be covered by Medicare and other insurance providers. 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 value is not established or the code is not priced separately by Part B. It is important to check with the specific insurance provider for coverage and reimbursement details.

8. Examples

Here are five examples of when HCPCS code G9294 should be billed:

1. A patient undergoes a biopsy, and the pathology report includes the patient category, a statement on thickness and ulceration, and for pt1, the mitotic rate. HCPCS code G9294 should be billed for this pathology report.
2. A patient with a suspected skin cancer lesion undergoes a surgical excision. The pathology report confirms the diagnosis and includes the required information. HCPCS code G9294 should be billed for this pathology report.
3. A patient with a melanoma diagnosis undergoes a sentinel lymph node biopsy. The pathology report includes the patient category, a statement on thickness and ulceration, and for pt1, the mitotic rate. HCPCS code G9294 should be billed for this pathology report.
4. A patient with a history of skin cancer undergoes a routine skin check. The pathology report from a biopsy of a suspicious lesion includes the required information. HCPCS code G9294 should be billed for this pathology report.
5. A patient with a diagnosis of basal cell carcinoma undergoes Mohs surgery. The pathology report includes the patient category, a statement on thickness and ulceration, and for pt1, the mitotic rate. HCPCS code G9294 should be billed for this pathology report.