How To Use HCPCS Code G9428

HCPCS code G9428 describes the pathology report for invasive tumors, providing important information about the tumor’s characteristics and margins. This code is used to identify the inclusion of the patient category, thickness, ulceration and mitotic rate, peripheral and deep margin status, and the presence or absence of microsatellitosis in the pathology report.

1. What is HCPCS G9428?

HCPCS code G9428 is a specific code used in medical coding to identify the inclusion of certain details in a pathology report for invasive tumors. It provides information about the patient category, tumor thickness, ulceration and mitotic rate, peripheral and deep margin status, and the presence or absence of microsatellitosis. This code is important for accurately documenting and reporting the characteristics of invasive tumors.

2. Official Description

The official description of HCPCS code G9428 is “Pathology report includes the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors.” The short description for this code is “Patho rpt incl pt ctg.”

3. Procedure

1. The provider obtains the pathology report for an invasive tumor.
2. The provider reviews the report to gather the necessary information.
3. The provider identifies and includes the patient category, tumor thickness, ulceration and mitotic rate, peripheral and deep margin status, and the presence or absence of microsatellitosis in the report.
4. The provider ensures that the report is accurate and complete.
5. The provider includes the pathology report with the patient’s medical records for documentation and billing purposes.

4. When to use HCPCS code G9428

HCPCS code G9428 should be used when documenting the pathology report for invasive tumors. It is specifically used to indicate the inclusion of the patient category, tumor thickness, ulceration and mitotic rate, peripheral and deep margin status, and the presence or absence of microsatellitosis in the report. This code is used to accurately report the characteristics of invasive tumors and ensure proper documentation and billing.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9428, healthcare providers need to ensure that the pathology report includes all the required information mentioned in the official description. The report should clearly state the patient category, tumor thickness, ulceration and mitotic rate, peripheral and deep margin status, and the presence or absence of microsatellitosis for invasive tumors. Providers should also include the pathology report with the patient’s medical records for proper documentation.

6. Historical Information and Code Maintenance

HCPCS code G9428 was added to the Healthcare Common Procedure Coding System on January 01, 2015. As of now, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important to stay updated with any future changes or revisions to the code.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the pathology report described by HCPCS code G9428. However, 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 may be bundled or not covered separately. It is important for healthcare providers to verify coverage and reimbursement policies with the respective payers.

8. Examples

Here are five examples of when HCPCS code G9428 should be billed:

1. A patient undergoes a biopsy for an invasive tumor, and the pathology report includes the patient category, tumor thickness, ulceration and mitotic rate, peripheral and deep margin status, and the presence of microsatellitosis.
2. A physician performs a wide local excision for an invasive tumor, and the pathology report provides all the required information mentioned in HCPCS code G9428.
3. A patient with an invasive tumor undergoes a sentinel lymph node biopsy, and the pathology report includes the necessary details for code G9428.
4. A surgeon performs a re-excision procedure for an invasive tumor, and the pathology report accurately documents the patient category, tumor thickness, ulceration and mitotic rate, peripheral and deep margin status, and the absence of microsatellitosis.
5. A patient receives radiation therapy for an invasive tumor, and the pathology report includes all the required information for HCPCS code G9428.