How To Use HCPCS Code G9547

HCPCS code G9547 describes a specific medical condition or procedure that is related to cystic renal lesions or adrenal lesions. This code is used to identify cases where the renal or adrenal lesion is simple appearing (Bosniak I or II) or where the adrenal lesion is less than or equal to 1.0 cm or greater than 1.0 cm but less than or equal to 4.0 cm and classified as likely benign by unenhanced CT or washout protocol CT, or MRI with in- and opposed-phase sequences or other equivalent institutional imaging protocols.

1. What is HCPCS G9547?

HCPCS code G9547 is a specific code that is used in medical coding to identify and describe a particular medical condition or procedure. In this case, the code is used to identify cases where there is a cystic renal lesion that is simple appearing (Bosniak I or II) or an adrenal lesion that is less than or equal to 1.0 cm or greater than 1.0 cm but less than or equal to 4.0 cm and classified as likely benign by certain imaging protocols.

2. Official Description

The official description of HCPCS code G9547 is “Cystic renal lesion that is simple appearing (Bosniak I or II), or adrenal lesion less than or equal to 1.0 cm or adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign by unenhanced CT or washout protocol CT, or MRI with in- and opposed-phase sequences or other equivalent institutional imaging protocols.” The short description for this code is “Cys ren les or adren.”

3. Procedure

1. The procedure for HCPCS code G9547 involves the identification and evaluation of cystic renal lesions or adrenal lesions. The healthcare provider will perform imaging tests such as CT scans or MRIs with specific sequences to determine the appearance and characteristics of the lesion.
2. If the cystic renal lesion is simple appearing (Bosniak I or II) or the adrenal lesion is less than or equal to 1.0 cm or greater than 1.0 cm but less than or equal to 4.0 cm and classified as likely benign by the imaging protocols, the HCPCS code G9547 can be used to report and bill for the service.

4. When to use HCPCS code G9547

HCPCS code G9547 should be used when documenting and coding cases where there is a cystic renal lesion that is simple appearing (Bosniak I or II) or an adrenal lesion that is less than or equal to 1.0 cm or greater than 1.0 cm but less than or equal to 4.0 cm and classified as likely benign by the specified imaging protocols. It is important to ensure that the criteria for using this code are met before assigning it to a patient’s medical record.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9547, healthcare providers need to document the specific details of the cystic renal lesion or adrenal lesion, including its size, appearance, and classification as likely benign. The documentation should also include information about the imaging protocols used to determine the benign nature of the lesion. Proper documentation is essential for accurate coding and billing.

6. Historical Information and Code Maintenance

HCPCS code G9547 was added to the Healthcare Common Procedure Coding System on January 01, 2016. As of January 01, 2020, 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 changes or revisions to the code, as well as any historical context related to its usage.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code G9547 may vary depending on the specific insurance provider or Medicare. It is important to check with the respective payer to determine if this code is payable and how it is priced. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which indicates that it is not applicable as HCPCS is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9547 should be billed:

1. A patient undergoes a CT scan for a cystic renal lesion, and the imaging report indicates that the lesion is simple appearing (Bosniak I or II) and likely benign. HCPCS code G9547 can be used to report and bill for this service.
2. A patient has an adrenal lesion that measures 0.8 cm and is classified as likely benign based on the washout protocol CT. HCPCS code G9547 can be used to report and bill for this service.
3. An MRI with in- and opposed-phase sequences is performed on a patient with an adrenal lesion measuring 3.5 cm. The imaging report confirms that the lesion is likely benign. HCPCS code G9547 can be used to report and bill for this service.
4. A patient undergoes an unenhanced CT scan for a cystic renal lesion, and the imaging report indicates that the lesion is simple appearing (Bosniak I or II) and likely benign. HCPCS code G9547 can be used to report and bill for this service.
5. An adrenal lesion measuring 2.5 cm is evaluated using an MRI with in- and opposed-phase sequences, and the imaging report classifies the lesion as likely benign. HCPCS code G9547 can be used to report and bill for this service.