How To Use HCPCS Code G9862

HCPCS code G9862 describes the documentation of medical reasons for not recommending at least a 10-year follow-up interval for certain procedures. This code is used to indicate that there are specific reasons why a longer follow-up interval is not recommended, such as inadequate preparation, familial or personal history of colonic polyps, the absence of adenoma in patients aged 66 years or older, a life expectancy of less than 10 years, or other medical reasons.

1. What is HCPCS G9862?

HCPCS code G9862 is a specific code used in medical coding to identify the documentation of medical reasons for not recommending at least a 10-year follow-up interval. It is important for medical coders to accurately assign this code to ensure proper reimbursement and documentation of the patient’s medical history.

2. Official Description

The official description of HCPCS code G9862 is “Documentation of medical reason(s) for not recommending at least a 10-year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons)." The short description for this code is "Doc rsn no 10 yr follow."

3. Procedure

1. When documenting medical reasons for not recommending at least a 10-year follow-up interval, healthcare providers should clearly state the specific reasons for this decision.
2. Providers should document any inadequate preparation for the procedure, such as insufficient bowel cleansing or other factors that may affect the accuracy of the follow-up interval.
3. If the patient has a familial or personal history of colonic polyps, this should be documented to support the decision for a shorter follow-up interval.
4. In cases where the patient had no adenoma and is 66 years old or older, this information should be documented to justify the recommendation for a different follow-up interval.
5. If the patient has a life expectancy of less than 10 years, this should be documented along with any other medical reasons that support the decision for a shorter follow-up interval.

4. When to use HCPCS code G9862

HCPCS code G9862 should be used when there are specific medical reasons documented for not recommending at least a 10-year follow-up interval. These reasons may include inadequate preparation, familial or personal history of colonic polyps, the absence of adenoma in patients aged 66 years or older, a life expectancy of less than 10 years, or other medical reasons. It is important for medical coders to review the documentation thoroughly to accurately assign this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9862, healthcare providers should ensure that the documentation supports the medical reasons for not recommending a 10-year follow-up interval. This may include detailed information on inadequate preparation, familial or personal history of colonic polyps, the absence of adenoma in patients aged 66 years or older, a life expectancy of less than 10 years, or other medical reasons. The documentation should be clear, concise, and support the medical necessity of the decision.

6. Historical Information and Code Maintenance

HCPCS code G9862 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 to stay updated on any changes or revisions to this code in order to accurately assign it during the coding process.

7. Medicare and Insurance Coverage

HCPCS code G9862 may be covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the service may be bundled or not covered by Medicare. Medical coders should review the specific guidelines and policies of the insurance provider to determine the coverage and reimbursement for this code.

8. Examples

Here are five examples of when HCPCS code G9862 should be billed:

1. A patient with a personal history of colonic polyps who requires a follow-up interval shorter than 10 years.
2. An elderly patient aged 66 years or older who had no adenoma and requires a different follow-up interval.
3. A patient with a life expectancy of less than 10 years who needs a shorter follow-up interval.
4. A patient with inadequate preparation for the procedure, necessitating a different follow-up interval.
5. A patient with other medical reasons documented that support the decision for a shorter follow-up interval.