How To Use HCPCS Code G9706

HCPCS code G9706 describes a low (or very low) risk of recurrence for prostate cancer. This code is used to identify patients who have a low likelihood of the cancer returning. It is important for medical coders to understand the meaning and usage of this code in order to accurately document and bill for the services provided.

1. What is HCPCS G9706?

HCPCS code G9706 is specifically used to indicate a low (or very low) risk of recurrence for prostate cancer. This code helps healthcare providers and insurers identify patients who have a lower likelihood of the cancer returning. It is important to note that this code is specific to prostate cancer and should not be used for other types of cancer or medical conditions.

2. Official Description

The official description for HCPCS code G9706 is “Low recur prost ca.” This short description succinctly conveys the meaning of the code, indicating that it is used to identify cases of prostate cancer with a low risk of recurrence.

3. Procedure

1. HCPCS code G9706 does not represent a specific procedure or treatment. Instead, it is used to classify the risk level of recurrence for prostate cancer patients.
2. Healthcare providers should assess the patient’s medical history, diagnostic test results, and other relevant factors to determine the risk level of recurrence.
3. Based on this assessment, the provider can assign the appropriate HCPCS code G9706 to indicate the low (or very low) risk of recurrence for prostate cancer.

4. When to use HCPCS code G9706

HCPCS code G9706 should be used when documenting and billing for patients with prostate cancer who have been assessed to have a low (or very low) risk of recurrence. It is important to ensure that the patient’s medical records clearly support the assignment of this code, including any relevant diagnostic test results or clinical assessments.

5. Billing Guidelines and Documentation Requirements

When billing for services associated with HCPCS code G9706, healthcare providers should ensure that the medical documentation supports the assignment of this code. This may include:

• Medical records indicating the patient’s diagnosis of prostate cancer
• Evidence of the assessment conducted to determine the risk level of recurrence
• Any relevant diagnostic test results or clinical assessments

It is important to accurately document and code the services provided to ensure proper reimbursement and to comply with coding and billing guidelines.

6. Historical Information and Code Maintenance

HCPCS code G9706 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. This code remains in use to identify cases of prostate cancer with a low (or very low) risk of recurrence.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover services associated with HCPCS code G9706, but coverage may vary depending on the specific policy and guidelines. It is important for healthcare providers to verify coverage and reimbursement policies with the respective payers to ensure proper billing and reimbursement.

8. Examples

Here are five examples of scenarios where HCPCS code G9706 may be used:

1. A patient with a history of prostate cancer who has undergone successful treatment and has been assessed to have a low risk of recurrence.
2. A patient who has undergone a prostatectomy and has been determined to have a very low risk of recurrence based on post-operative assessments.
3. A patient with a history of prostate cancer who has been on active surveillance and has consistently shown no signs of disease progression or recurrence.
4. A patient who has completed a course of radiation therapy for prostate cancer and has been assessed to have a low risk of recurrence based on post-treatment evaluations.
5. A patient with a history of prostate cancer who has been on hormonal therapy and has shown a significant reduction in tumor markers, indicating a low risk of recurrence.