How To Use HCPCS Code G9346

HCPCS code G9346 describes the situation where follow-up recommendations for incidentally detected pulmonary nodules are not documented according to recommended guidelines due to medical reasons. This code is used for patients with known malignant disease, patients with unexplained fever, CT studies performed for radiation treatment planning, or image-guided radiation treatment delivery. It is important for medical coders to understand the specific meaning and usage of this code to ensure accurate billing and reimbursement.

1. What is HCPCS G9346?

HCPCS code G9346 is a specific code used in medical coding to identify cases where follow-up recommendations for incidentally detected pulmonary nodules are not documented according to recommended guidelines. It is important to note that this code is only applicable for patients with medical reasons such as known malignant disease, unexplained fever, CT studies performed for radiation treatment planning, or image-guided radiation treatment delivery. It is crucial for medical coders to accurately assign this code to ensure proper documentation and billing.

2. Official Description

The official description of HCPCS code G9346 is “Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules due to medical reasons (e.g., patients with known malignant disease, patients with unexplained fever, CT studies performed for radiation treatment planning or image-guided radiation treatment delivery).” The short description for this code is “No follow-up pulm nod.”

3. Procedure

1. When assigning HCPCS code G9346, the medical coder should review the patient’s medical records and determine if there are any incidentally detected pulmonary nodules.
2. If there are incidentally detected pulmonary nodules, the coder should check if follow-up recommendations for these nodules are documented according to recommended guidelines.
3. If the follow-up recommendations are not documented due to medical reasons such as known malignant disease, unexplained fever, CT studies performed for radiation treatment planning, or image-guided radiation treatment delivery, the coder should assign HCPCS code G9346.
4. It is important to accurately document the medical reasons for not following the recommended guidelines in the patient’s medical records.

4. When to use HCPCS code G9346

HCPCS code G9346 should be used in cases where follow-up recommendations for incidentally detected pulmonary nodules are not documented according to recommended guidelines. This code is specifically applicable for patients with medical reasons such as known malignant disease, unexplained fever, CT studies performed for radiation treatment planning, or image-guided radiation treatment delivery. It is important to review the patient’s medical records and ensure that the specific criteria for using this code are met before assigning it.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9346, healthcare providers need to ensure that the medical reasons for not following the recommended guidelines are clearly documented in the patient’s medical records. This documentation should include details about the patient’s known malignant disease, unexplained fever, or the purpose of the CT studies performed for radiation treatment planning or image-guided radiation treatment delivery. Accurate and thorough documentation is essential for proper billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9346 was added to the Healthcare Common Procedure Coding System on January 1, 2014. It has a termination date of December 31, 2015. This code has no maintenance actions, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders to stay updated on any changes or revisions to this code to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

HCPCS code G9346 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. It is important to follow the specific billing guidelines and requirements of Medicare and other insurance providers when submitting claims for this code to ensure proper reimbursement.

8. Examples

Here are some examples of when HCPCS code G9346 should be billed:

1. A patient with a known malignant disease has incidentally detected pulmonary nodules, but the follow-up recommendations are not documented according to recommended guidelines.
2. A patient with unexplained fever has incidentally detected pulmonary nodules, but the follow-up recommendations are not documented according to recommended guidelines.
3. A patient undergoes CT studies for radiation treatment planning, and incidentally detected pulmonary nodules are found. However, the follow-up recommendations for these nodules are not documented according to recommended guidelines.
4. A patient undergoes image-guided radiation treatment delivery, and incidentally detected pulmonary nodules are discovered. However, the follow-up recommendations for these nodules are not documented according to recommended guidelines.
5. A patient with a known malignant disease undergoes CT studies for radiation treatment planning, and incidentally detected pulmonary nodules are found. However, the follow-up recommendations for these nodules are not documented according to recommended guidelines.