How To Use HCPCS Code G9823

HCPCS code G9823 describes a specific procedure known as endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation. This code is used to identify and bill for this particular medical service. In this article, we will delve into the details of HCPCS code G9823, 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 G9823?

HCPCS code G9823 is a specific code used in medical coding to identify the procedure of endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation. This code allows healthcare providers to accurately document and bill for this particular service.

2. Official Description

The official description of HCPCS code G9823 is “Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation.” The short description for this code is “Endo smpl/hyst bx res doc.”

3. Procedure

1. Prepare the patient for the procedure by explaining the process and obtaining informed consent.
2. Position the patient in the appropriate position for endometrial sampling or hysteroscopy.
3. Administer anesthesia, if necessary, to ensure patient comfort during the procedure.
4. Perform endometrial sampling or hysteroscopy, following established medical guidelines and protocols.
5. Collect biopsy samples from the endometrium for further analysis.
6. Document the results of the biopsy and any relevant findings during the 12 months prior to the index date of the endometrial ablation.
7. Ensure proper documentation of the procedure in the patient’s medical record.

4. When to use HCPCS code G9823

HCPCS code G9823 should be used when healthcare providers perform endometrial sampling or hysteroscopy with biopsy and document the results during the 12 months prior to the index date of the endometrial ablation. This code is specific to this particular procedure and should not be used for other unrelated services or supplies.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9823, healthcare providers need to ensure proper documentation of the procedure and the results of the biopsy. This documentation should include the date of the procedure, the patient’s medical history, the specific findings of the biopsy, and any other relevant information. It is important to follow the billing guidelines set forth by the relevant insurance carriers and Medicare to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9823 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of the effective date of January 01, 2022, 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 healthcare providers to stay updated on any changes or revisions to HCPCS codes to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

The coverage for HCPCS code G9823 is determined by the carrier judgment, as indicated by the coverage code C. This means that the coverage for this code may vary depending on the specific insurance carrier or Medicare. 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. The multiple pricing indicator code is 9, which means that the value for this code is not established or applicable. It is important to verify the coverage and pricing with the relevant insurance carriers or Medicare before billing for this service.

8. Examples

Here are five examples of when HCPCS code G9823 should be billed:

1. A 45-year-old female patient undergoes endometrial sampling with biopsy due to abnormal uterine bleeding. The results of the biopsy are documented in the patient’s medical record.
2. A 50-year-old female patient with a history of endometrial hyperplasia undergoes hysteroscopy with biopsy to monitor the progression of the condition. The results of the biopsy are documented during the 12 months prior to the index date of the endometrial ablation.
3. A 35-year-old female patient with a family history of endometrial cancer undergoes endometrial sampling with biopsy as a preventive measure. The results of the biopsy are documented in the patient’s medical record.
4. A 55-year-old female patient with postmenopausal bleeding undergoes hysteroscopy with biopsy to investigate the cause of the bleeding. The results of the biopsy are documented during the 12 months prior to the index date of the endometrial ablation.
5. A 40-year-old female patient with a history of polycystic ovary syndrome undergoes endometrial sampling with biopsy to assess the thickness of the endometrium. The results of the biopsy are documented in the patient’s medical record.