How To Use HCPCS Code G9754

HCPCS code G9754 describes a finding of an incidental pulmonary nodule. This code is used to identify the presence of a small abnormality in the lung that is discovered unintentionally during a medical examination or imaging study. It is important for medical coders to understand the specific meaning and usage of this code in order to accurately document and bill for this service.

1. What is HCPCS G9754?

HCPCS code G9754 is a unique alphanumeric code that is part of the Healthcare Common Procedure Coding System (HCPCS). It is used to identify a specific medical service or supply provided to a patient. In the case of G9754, it represents the finding of an incidental pulmonary nodule.

2. Official Description

The official description of HCPCS code G9754 is “A finding of an incidental pulmonary nodule.” The short description is “Incid pulm nodule.” This description accurately reflects the purpose of the code, which is to document the discovery of an abnormality in the lung that was not the primary reason for the medical examination or imaging study.

3. Procedure

  1. The procedure for documenting HCPCS code G9754 involves identifying the presence of an incidental pulmonary nodule during a medical examination or imaging study.
  2. The healthcare provider should carefully review the patient’s medical records and imaging results to determine if a pulmonary nodule is present.
  3. If a nodule is found, the provider should document the size, location, and any other relevant characteristics of the nodule.
  4. The provider should also note whether any further diagnostic tests or follow-up appointments are recommended based on the presence of the nodule.

4. When to use HCPCS code G9754

HCPCS code G9754 should be used when a healthcare provider discovers an incidental pulmonary nodule during a medical examination or imaging study. It is important to note that this code is specifically for incidental findings and should not be used for primary diagnoses or conditions that were the primary reason for the medical encounter.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9754, healthcare providers should ensure that the documentation supports the presence of an incidental pulmonary nodule. This may include the medical records, imaging reports, and any additional documentation related to the nodule.

6. Historical Information and Code Maintenance

HCPCS code G9754 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.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may have specific coverage policies for HCPCS code G9754. It is important for healthcare providers to familiarize themselves with these policies to ensure proper reimbursement for the service. The pricing indicator code for G9754 is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled with other services or not covered by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code G9754 should be billed:

  1. A patient undergoes a routine chest X-ray for a different medical condition, and a small pulmonary nodule is incidentally discovered.
  2. A CT scan is performed to evaluate a patient’s abdominal pain, and an incidental pulmonary nodule is identified in the lung.
  3. A patient undergoes a PET scan for cancer staging, and a small nodule is found in the lung that was not previously known.
  4. An MRI is performed to assess a patient’s spinal cord injury, and an incidental pulmonary nodule is detected.
  5. A routine physical examination includes a chest auscultation, and a suspicious lung nodule is heard during the examination.

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