How To Use HCPCS Code G9345

HCPCS code G9345 describes the follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules. This code is used to indicate the need for follow-up CT imaging studies or to indicate that no follow-up is needed, based on the size of the nodule and patient risk factors.

1. What is HCPCS G9345?

HCPCS code G9345 is a specific code used in medical coding to identify the follow-up recommendations for incidentally detected pulmonary nodules. It is important to note that this code is not used to identify the initial detection or diagnosis of the pulmonary nodule, but rather the subsequent recommendations for further evaluation or monitoring.

2. Official Description

The official description of HCPCS code G9345 is “Follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up CT imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors.” The short description for this code is “Follow up pulm nod.”

3. Procedure

1. The healthcare provider first identifies an incidentally detected pulmonary nodule during a diagnostic imaging study or examination.
2. They then assess the size of the nodule and evaluate the patient’s risk factors.
3. Based on the recommended guidelines, the provider determines the appropriate follow-up recommendations for the patient.
4. If further evaluation is necessary, the provider may order follow-up CT imaging studies to monitor the nodule over time.
5. If the nodule is determined to be low-risk or benign, the provider may document that no follow-up is needed.

4. When to use HCPCS code G9345

HCPCS code G9345 should be used when documenting the follow-up recommendations for incidentally detected pulmonary nodules. It is important to use this code only for the specific purpose of indicating the need for follow-up CT imaging studies or documenting that no follow-up is needed, based on the nodule size and patient risk factors.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9345, healthcare providers need to ensure that they have documented the follow-up recommendations according to the recommended guidelines. This documentation should include the specific follow-up recommendations, such as the need for follow-up CT imaging studies or the determination that no follow-up is needed. It is important to accurately code and document the size of the pulmonary nodule and any relevant patient risk factors.

6. Historical Information and Code Maintenance

HCPCS code G9345 was added to the Healthcare Common Procedure Coding System on January 01, 2014. As of January 01, 2015, 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 G9345 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the service is bundled or not covered separately. The multiple pricing indicator code is 9, which means that the value for this code is not established. It is important for healthcare providers to review the specific coverage and reimbursement policies of Medicare and other insurance providers for accurate billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G9345 should be billed:

1. A patient undergoes a CT scan for an unrelated condition, and an incidentally detected pulmonary nodule is identified. The provider determines that the nodule is small and low-risk, and documents that no follow-up is needed. HCPCS code G9345 is used to indicate this recommendation.
2. A patient with a history of smoking undergoes a CT scan, and a pulmonary nodule is incidentally detected. The nodule is of moderate size, and the provider recommends follow-up CT imaging studies in six months to monitor the nodule. HCPCS code G9345 is used to indicate this recommendation.
3. A patient with a known history of lung cancer undergoes a follow-up CT scan, and a new pulmonary nodule is incidentally detected. The provider determines that the nodule is large and high-risk, and orders immediate follow-up CT imaging studies for further evaluation. HCPCS code G9345 is used to indicate this recommendation.
4. A patient undergoes a routine chest X-ray, and an incidentally detected pulmonary nodule is identified. The nodule is small and low-risk, and the provider documents that no follow-up is needed. HCPCS code G9345 is used to indicate this recommendation.
5. A patient with a history of asbestos exposure undergoes a CT scan, and a pulmonary nodule is incidentally detected. The nodule is of moderate size, and the provider recommends follow-up CT imaging studies in three months to monitor the nodule. HCPCS code G9345 is used to indicate this recommendation.