How To Use HCPCS Code G9897

HCPCS code G9897 describes patients who were not prescribed or administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, and the reason for not receiving this therapy is not specified. This code falls under the category of medical care and is not separately priced by Part B of Medicare. In this article, we will explore the details of HCPCS code G9897, 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 G9897?

HCPCS code G9897 is used to identify patients who were not prescribed or administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, and the reason for not receiving this therapy is not specified. This code is used to capture specific information about the treatment plan and decisions made by healthcare providers regarding the use of androgen deprivation therapy in prostate cancer patients.

2. Official Description

The official description of HCPCS code G9897 is “Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given.” The short description is “Pt nt prsc adr dep thrpy rng.”

3. Procedure

1. The healthcare provider assesses the patient’s medical history and determines the appropriate treatment plan for prostate cancer.
2. If the decision is made not to prescribe or administer androgen deprivation therapy in combination with external beam radiotherapy to the prostate, the reason for this decision is documented.
3. The healthcare provider assigns HCPCS code G9897 to indicate that the patient did not receive androgen deprivation therapy in combination with external beam radiotherapy to the prostate, and the reason for not receiving this therapy is not specified.

4. When to use HCPCS code G9897

HCPCS code G9897 should be used when a patient with prostate cancer was not prescribed or administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, and the reason for not receiving this therapy is not specified. It is important to accurately document the reason for not prescribing or administering this therapy, as it may impact the patient’s treatment plan and future healthcare decisions.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9897, healthcare providers should ensure that the reason for not prescribing or administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate is clearly documented in the patient’s medical record. This documentation should support the medical necessity and appropriateness of the treatment plan. Additionally, providers should follow the billing guidelines set forth by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9897 was added to the Healthcare Common Procedure Coding System on January 01, 2018. 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 healthcare providers to stay updated on any changes or revisions to HCPCS codes to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

HCPCS code G9897 is not separately priced by Part B of Medicare. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. Additionally, the multiple pricing indicator code is 9, which means that the code is not applicable as HCPCS is not priced separately by Part B or the value is not established. It is important to check with individual insurance carriers regarding coverage and reimbursement policies for HCPCS code G9897.

8. Examples

Here are five examples of when HCPCS code G9897 should be billed:

1. A patient with prostate cancer who has a contraindication to androgen deprivation therapy and is not a candidate for this treatment.
2. A patient with prostate cancer who has chosen to pursue alternative treatment options and has declined androgen deprivation therapy.
3. A patient with prostate cancer who has completed a course of external beam radiotherapy to the prostate without the addition of androgen deprivation therapy.
4. A patient with prostate cancer who has a limited life expectancy and the potential benefits of androgen deprivation therapy do not outweigh the potential risks and side effects.
5. A patient with prostate cancer who is participating in a clinical trial that excludes the use of androgen deprivation therapy in combination with external beam radiotherapy to the prostate.