How To Use HCPCS Code G9900

HCPCS code G9900 describes the screening or diagnostic mammography results that were not documented and reviewed, without specifying the reason for the omission. This code is used to indicate that the results of a film, digital, or digital breast tomosynthesis (3D) mammography were not properly documented and reviewed by the healthcare provider.

1. What is HCPCS G9900?

HCPCS code G9900 is a specific code used in medical coding to identify the situation where the screening or diagnostic mammography results were not documented and reviewed. It is important for medical coders to accurately assign this code when the specific circumstances described by the code are present in the patient’s medical record.

2. Official Description

The official description of HCPCS code G9900 is “Screening, diagnostic, film, digital or digital breast tomosynthesis (3D) mammography results were not documented and reviewed, reason not otherwise specified.” The short description for this code is “Scrn mam perf rslts not doc.”

3. Procedure

1. The healthcare provider performs a screening or diagnostic mammography on the patient.
2. After the mammography is performed, the results are expected to be documented and reviewed by the healthcare provider.
3. In the case where the results are not documented and reviewed, the healthcare provider should assign HCPCS code G9900 to indicate this omission.

4. When to use HCPCS code G9900

HCPCS code G9900 should be used when the screening or diagnostic mammography results were not properly documented and reviewed by the healthcare provider. The reason for the omission is not specified by this code, so it can be used in various situations where the documentation and review of the mammography results were not performed.

5. Billing Guidelines and Documentation Requirements

When billing for the service associated with HCPCS code G9900, healthcare providers need to ensure that the documentation clearly indicates that the screening or diagnostic mammography results were not documented and reviewed. This information should be included in the patient’s medical record and should be easily accessible for review by auditors or insurance companies if necessary.

6. Historical Information and Code Maintenance

HCPCS code G9900 was added to the Healthcare Common Procedure Coding System on January 01, 2018. As of now, 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

HCPCS code G9900 is not separately priced by Medicare or other insurers. It falls under the pricing indicator code 00, which means that the service is not separately priced by Part B. This indicates that the service is either not covered, bundled with other services, or used exclusively by Part A. The multiple pricing indicator code for G9900 is 9, which means that the value for this code is not established.

8. Examples

Here are five examples of scenarios where HCPCS code G9900 should be billed:

1. A patient undergoes a screening mammography, but the results are not documented and reviewed by the healthcare provider.
2. A diagnostic mammography is performed on a patient, but the results are not properly documented and reviewed.
3. A digital breast tomosynthesis (3D) mammography is conducted, but the results are not documented and reviewed by the healthcare provider.
4. After a film mammography, the results are not documented and reviewed, leading to the assignment of HCPCS code G9900.
5. A patient undergoes a digital mammography, but the healthcare provider fails to document and review the results, necessitating the use of HCPCS code G9900.