How To Use HCPCS Code G9899

HCPCS code G9899 describes the screening, diagnostic, film, digital, or digital breast tomosynthesis (3D) mammography results documented and reviewed. This code is used to indicate that the results of a mammogram have been documented and reviewed by a healthcare provider. In this article, we will explore the details of HCPCS code G9899, 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 G9899?

HCPCS code G9899 is a specific code used to identify the screening, diagnostic, film, digital, or digital breast tomosynthesis (3D) mammography results documented and reviewed. It is important to note that this code is specific to mammography results and should not be used for other types of imaging or diagnostic procedures.

2. Official Description

The official description of HCPCS code G9899 is “Screening, diagnostic, film, digital or digital breast tomosynthesis (3D) mammography results documented and reviewed.” The short description for this code is “Scrn mam perf rslts doc.”

3. Procedure

1. The procedure for HCPCS code G9899 involves performing a screening, diagnostic, film, digital, or digital breast tomosynthesis (3D) mammography.
2. After the mammography is performed, the results are documented by the healthcare provider.
3. The documented results are then reviewed by the healthcare provider to ensure accuracy and appropriate follow-up.

4. When to use HCPCS code G9899

HCPCS code G9899 should be used when the results of a screening, diagnostic, film, digital, or digital breast tomosynthesis (3D) mammography have been documented and reviewed by a healthcare provider. It is important to use this code only in the context of mammography results and not for other types of imaging or diagnostic procedures.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9899, healthcare providers need to document the screening, diagnostic, film, digital, or digital breast tomosynthesis (3D) mammography results and the review process. This documentation should include the date of the mammography, the findings, any recommendations or follow-up plans, and the name and credentials of the reviewing healthcare provider.

6. Historical Information and Code Maintenance

HCPCS code G9899 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. This code is still active and can be used for billing purposes.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G9899 may vary. It is important to check with the specific payer for their coverage policies and guidelines. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This indicates that the service may be bundled or not covered by Medicare or other insurers. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9899 should be billed:

1. A patient undergoes a screening mammography, and the results are documented and reviewed by the radiologist.
2. A patient with a history of breast cancer undergoes a diagnostic mammography, and the results are documented and reviewed by the oncologist.
3. A patient with a family history of breast cancer undergoes a digital breast tomosynthesis (3D) mammography, and the results are documented and reviewed by the gynecologist.
4. A patient with a suspicious lump undergoes a film mammography, and the results are documented and reviewed by the surgeon.
5. A patient with dense breast tissue undergoes a digital mammography, and the results are documented and reviewed by the primary care physician.