How To Use HCPCS Code G9708

HCPCS code G9708 describes the specific circumstances under which a bilateral mastectomy has been performed or a patient has a history of a bilateral mastectomy, or there is evidence of a right and left unilateral mastectomy. This code is used to identify and bill for services related to these mastectomy procedures. In this article, we will explore the details of HCPCS code G9708, 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 G9708?

HCPCS code G9708 is a specific code used to identify and bill for services related to bilateral mastectomy procedures or patients with a history of bilateral mastectomy or evidence of a right and left unilateral mastectomy. It is important to use this code accurately to ensure proper reimbursement and documentation of these procedures.

2. Official Description

The official description of HCPCS code G9708 is “Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy.” The short description is “Bilat mast/hx bi/unilat mas.”

3. Procedure

1. During a bilateral mastectomy procedure, the surgeon removes both breasts to treat or prevent breast cancer or other medical conditions.
2. The procedure typically involves making incisions in the breast tissue and removing the breast tissue, including the nipple and areola.
3. In some cases, breast reconstruction may be performed immediately after the mastectomy procedure.
4. Post-operative care and follow-up visits are also part of the overall procedure for patients who have undergone a bilateral mastectomy.

4. When to use HCPCS code G9708

HCPCS code G9708 should be used when documenting and billing for services related to bilateral mastectomy procedures or patients with a history of bilateral mastectomy or evidence of a right and left unilateral mastectomy. It is important to ensure that the patient’s medical records clearly indicate the need for this code based on the specific circumstances of the mastectomy procedure.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9708, healthcare providers need to ensure that the medical documentation supports the use of this code. This includes documenting the patient’s history of bilateral mastectomy or evidence of a right and left unilateral mastectomy. Additionally, any relevant surgical reports, pathology reports, or other supporting documentation should be included to substantiate the need for this code.

6. Historical Information and Code Maintenance

HCPCS code G9708 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 for medical coders and billers to stay updated on any changes or revisions to this code in the future.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code G9708 may vary depending on the specific policies of Medicare and other insurance providers. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare or other insurers. It is important to review the specific coverage policies and guidelines of the payer to determine the reimbursement for services related to HCPCS code G9708.

8. Examples

Here are five examples of when HCPCS code G9708 should be billed:

1. A patient with a history of bilateral mastectomy undergoes a follow-up visit with their surgeon to monitor their post-operative recovery.
2. A patient who had a bilateral mastectomy requires breast reconstruction surgery to restore the appearance of their breasts.
3. A patient presents with evidence of a right and left unilateral mastectomy and requires genetic testing to assess their risk of developing breast cancer.
4. A patient who had a bilateral mastectomy receives counseling and support services to help them cope with the emotional and psychological impact of the procedure.
5. A patient with a history of bilateral mastectomy undergoes a mammogram to screen for any signs of recurrence or new breast abnormalities.