How To Use HCPCS Code G9839

HCPCS code G9839 describes the use of anti-EGFR monoclonal antibody therapy. This article will provide a comprehensive overview of this specific HCPCS code, including its official description, procedure details, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and examples of when this code should be billed.

1. What is HCPCS G9839?

HCPCS code G9839 is used to identify anti-EGFR monoclonal antibody therapy. This therapy involves the administration of monoclonal antibodies that target the epidermal growth factor receptor (EGFR), a protein found on the surface of certain cancer cells. By inhibiting the activity of EGFR, this therapy aims to slow down or stop the growth of cancer cells.

2. Official Description

The official description of HCPCS code G9839 is “Anti-egfr monoclonal antibody therapy.” The short description is “Anti-egfr mon anti ther.”

3. Procedure

1. The provider begins by assessing the patient’s eligibility for anti-EGFR monoclonal antibody therapy. This may involve reviewing the patient’s medical history, conducting diagnostic tests, and consulting with other healthcare professionals.
2. If the patient is deemed eligible, the provider determines the appropriate dosage and frequency of the therapy based on the patient’s specific condition and treatment goals.
3. The provider administers the anti-EGFR monoclonal antibody therapy to the patient. This may involve intravenous infusion or subcutaneous injection, depending on the specific medication being used.
4. During the course of treatment, the provider closely monitors the patient’s response to the therapy, assessing its effectiveness and managing any potential side effects.
5. The provider may adjust the dosage or frequency of the therapy as needed, based on the patient’s individual response and any changes in their condition.
6. Once the course of anti-EGFR monoclonal antibody therapy is completed, the provider evaluates the patient’s overall response and determines the next steps in their treatment plan.

4. When to use HCPCS code G9839

HCPCS code G9839 should be used when reporting anti-EGFR monoclonal antibody therapy. It is important to ensure that the therapy meets the specific criteria outlined by the carrier or payer. Providers should review the carrier’s guidelines and documentation requirements to ensure accurate reporting and reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for anti-EGFR monoclonal antibody therapy using HCPCS code G9839, healthcare providers should ensure that the following documentation is included:

• Medical records supporting the patient’s eligibility for the therapy
• Documentation of the specific medication used and its dosage
• Details of the administration method (e.g., intravenous infusion, subcutaneous injection)
• Monitoring and assessment of the patient’s response to the therapy
• Any adjustments made to the dosage or frequency of the therapy
• Evaluation of the patient’s overall response and treatment outcomes

6. Historical Information and Code Maintenance

HCPCS code G9839 was added to the Healthcare Common Procedure Coding System on January 01, 2017. Since its addition, 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

The coverage of HCPCS code G9839 may vary depending on the carrier or payer. It is important for healthcare providers to review the specific guidelines and policies of Medicare or other insurance providers to determine if this therapy is payable. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value is not established or the code is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G9839 should be billed:

1. A patient with metastatic colorectal cancer receives anti-EGFR monoclonal antibody therapy as part of their treatment plan.
2. A patient with non-small cell lung cancer undergoes anti-EGFR monoclonal antibody therapy to target specific cancer cells.
3. A patient with head and neck cancer receives anti-EGFR monoclonal antibody therapy to inhibit the growth of cancer cells.
4. A patient with pancreatic cancer undergoes anti-EGFR monoclonal antibody therapy to slow down the progression of the disease.
5. A patient with metastatic renal cell carcinoma receives anti-EGFR monoclonal antibody therapy to target cancer cells and improve treatment outcomes.