How To Use HCPCS Code G9704

HCPCS code G9704 describes the AJCC breast cancer stage I: T1 mic or T1a documented. This code is used to identify and bill for specific medical services related to the diagnosis and treatment of breast cancer in its early stages. In this article, we will explore the details of HCPCS code G9704, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9704?

HCPCS code G9704 is a specific code used in medical coding to identify and bill for the AJCC breast cancer stage I: T1 mic or T1a documented. This code is part of the Healthcare Common Procedure Coding System (HCPCS) and is used by healthcare providers and medical coders to accurately document and bill for services related to the diagnosis and treatment of breast cancer in its early stages.

2. Official Description

The official description of HCPCS code G9704 is “AJCC breast cancer stage I: T1 mic or T1a documented.” The short description of this code is “Ajcc br ca stg i: t1 mic/t1a.” These descriptions provide a concise summary of the specific breast cancer stage and documentation requirements associated with this code.

3. Procedure

  1. Step 1: The healthcare provider evaluates the patient’s medical history, performs a physical examination, and orders relevant diagnostic tests to determine the stage of breast cancer.
  2. Step 2: If the patient is diagnosed with AJCC breast cancer stage I and meets the criteria of T1 mic or T1a, the provider documents this information in the patient’s medical record.
  3. Step 3: The provider may recommend further diagnostic tests or treatment options based on the specific stage and characteristics of the breast cancer.
  4. Step 4: The provider continues to monitor the patient’s condition and adjust the treatment plan as necessary.

4. When to use HCPCS code G9704

HCPCS code G9704 should be used when documenting and billing for medical services related to AJCC breast cancer stage I with T1 mic or T1a. It is important to ensure that the patient’s medical record clearly indicates the stage and documentation supporting the use of this code. Only use this code when the patient’s condition meets the specific criteria outlined in the official description.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9704, healthcare providers need to ensure accurate and detailed documentation in the patient’s medical record. This documentation should include the stage of breast cancer, T1 mic or T1a documentation, and any other relevant information supporting the use of this code. Proper documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9704 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of the effective date, 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 HCPCS codes to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover services billed with HCPCS code G9704. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This could indicate that the service is bundled or not covered by Medicare. It is important to verify coverage and pricing with the specific insurance provider to ensure proper reimbursement.

8. Examples

Here are five examples of when HCPCS code G9704 should be billed:

  1. Example 1: A patient is diagnosed with AJCC breast cancer stage I, with T1 mic documented in their medical record. The healthcare provider performs a lumpectomy to remove the tumor. HCPCS code G9704 should be used to bill for this procedure.
  2. Example 2: A patient with AJCC breast cancer stage I, with T1a documented, undergoes radiation therapy as part of their treatment plan. HCPCS code G9704 should be used to bill for the radiation therapy sessions.
  3. Example 3: A patient with AJCC breast cancer stage I, with T1 mic or T1a documented, receives chemotherapy treatment. HCPCS code G9704 should be used to bill for the chemotherapy sessions.
  4. Example 4: A patient with AJCC breast cancer stage I, with T1a documented, undergoes a sentinel lymph node biopsy. HCPCS code G9704 should be used to bill for the biopsy procedure.
  5. Example 5: A patient with AJCC breast cancer stage I, with T1 mic or T1a documented, receives hormonal therapy as part of their treatment plan. HCPCS code G9704 should be used to bill for the hormonal therapy sessions.

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