HCPCS code G9607 describes the documented medical reasons for not performing intraoperative cystoscopy. This code is used when there are specific circumstances that prevent the healthcare provider from performing the cystoscopy procedure during a surgical operation. It is important for medical coders to understand the meaning and usage of this code to accurately report and bill for the services provided.
1. What is HCPCS G9607?
HCPCS code G9607 is a specific code used to identify the documented medical reasons for not performing intraoperative cystoscopy. It is important to note that this code should only be used when there are valid medical reasons for not performing the procedure, such as urethral pathology precluding cystoscopy or the absence of the urethra due to a congenital or acquired condition. This code is not applicable in cases of patient death.
2. Official Description
The official description of HCPCS code G9607 is “Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death.” The short description for this code is “Doc med rsn not perf cystosc.”
3. Procedure
- The healthcare provider should thoroughly document the medical reasons for not performing intraoperative cystoscopy.
- These reasons may include urethral pathology that prevents the safe insertion of the cystoscope or the absence of the urethra due to a congenital or acquired condition.
- The documentation should clearly explain why the procedure was not performed and provide supporting evidence or medical findings.
- It is important for the healthcare provider to accurately document the specific medical reasons to justify the use of HCPCS code G9607.
4. When to use HCPCS code G9607
HCPCS code G9607 should be used when there are documented medical reasons for not performing intraoperative cystoscopy. These reasons may include urethral pathology that precludes the safe insertion of the cystoscope or the absence of the urethra due to a congenital or acquired condition. It is important to ensure that the medical documentation clearly supports the use of this code and justifies the non-performance of the procedure.
5. Billing Guidelines and Documentation Requirements
When billing for services using HCPCS code G9607, healthcare providers should ensure that the medical documentation clearly supports the medical reasons for not performing intraoperative cystoscopy. The documentation should include detailed information about the specific condition or pathology that prevented the procedure, as well as any relevant medical findings or test results. It is important to accurately code and bill for the services provided, ensuring compliance with all applicable coding and billing guidelines.
6. Historical Information and Code Maintenance
HCPCS code G9607 was added to the Healthcare Common Procedure Coding System on January 01, 2016. As of January 01, 2018, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code is not separately priced by Part B and has a pricing indicator code of 00, which means the service is not separately priced. The multiple pricing indicator code is 9, indicating that the value for this code is not established.
7. Medicare and Insurance Coverage
Medicare and other insurance coverage for HCPCS code G9607 may vary. It is important to consult the specific coverage guidelines and policies of the insurance provider to determine if this code is payable. The pricing indicator code of 00 indicates that the service is not separately priced by Part B, and the multiple pricing indicator code of 9 indicates that the value for this code is not established. Healthcare providers should ensure that they follow the appropriate billing and reimbursement guidelines when reporting this code to Medicare or other insurance carriers.
8. Examples
Here are some examples of when HCPCS code G9607 should be billed:
- A patient with a documented congenital absence of the urethra undergoes a surgical procedure that would typically require intraoperative cystoscopy. Due to the absence of the urethra, the healthcare provider is unable to perform the cystoscopy and documents the medical reason for not performing the procedure using HCPCS code G9607.
- A patient with urethral pathology that precludes the safe insertion of the cystoscope undergoes a surgical procedure. The healthcare provider determines that it is not medically appropriate to perform the cystoscopy and documents the specific pathology as the medical reason for not performing the procedure using HCPCS code G9607.
- In the unfortunate event of a patient’s death during a surgical procedure, the healthcare provider is unable to perform the intraoperative cystoscopy. HCPCS code G9607 is used to document the medical reason for not performing the procedure in this case.
- A patient with a documented acquired absence of the urethra undergoes a surgical procedure that would typically require intraoperative cystoscopy. Due to the absence of the urethra, the healthcare provider is unable to perform the cystoscopy and documents the medical reason for not performing the procedure using HCPCS code G9607.
- A patient with a history of urethral pathology that precludes the safe insertion of the cystoscope undergoes a surgical procedure. The healthcare provider determines that it is not medically appropriate to perform the cystoscopy and documents the specific pathology as the medical reason for not performing the procedure using HCPCS code G9607.
