How To Use HCPCS Code G9934

HCPCS code G9934 describes the documentation required when a neoplasm is detected and diagnosed as either a traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma. This code is used to indicate that the healthcare provider has determined that the neoplasm does not involve cancer.

1. What is HCPCS G9934?

HCPCS code G9934 is a specific code used in medical coding to identify and document cases where a neoplasm is detected and diagnosed as a traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma. It is important to use this code accurately to ensure proper documentation and billing for the services provided.

2. Official Description

The official description of HCPCS code G9934 is “Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma.” The short description for this code is “Doc rsn not detecting cancer.”

3. Procedure

1. When documenting a case where a neoplasm is detected and diagnosed as a traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma, the healthcare provider should clearly indicate the findings in the patient’s medical record.
2. The documentation should include detailed information about the neoplasm, including its location, size, and any other relevant characteristics.
3. The provider should also specify that the neoplasm does not involve cancer and provide supporting evidence or rationale for this diagnosis.
4. It is important to ensure accurate and thorough documentation to support proper coding and billing for the services provided.

4. When to use HCPCS code G9934

HCPCS code G9934 should be used in cases where a neoplasm is detected and diagnosed as a traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma, and the provider determines that it does not involve cancer. This code should only be used when these specific conditions are met.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9934, healthcare providers need to ensure that the documentation supports the use of this code. The medical record should clearly indicate the diagnosis of a traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma, and provide evidence or rationale for determining that the neoplasm does not involve cancer.

6. Historical Information and Code Maintenance

HCPCS code G9934 was added to the Healthcare Common Procedure Coding System on January 01, 2018. It has an effective date of January 01, 2021. As of December 31, 2020, this code has been terminated and is no longer in use. 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 for HCPCS code G9934 may vary depending on the insurance provider. It is important to check with the specific insurance company or Medicare to determine if this code is payable and what the reimbursement rates may be. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which indicates that the value is not established or applicable for separate pricing.

8. Examples

Here are five examples of when HCPCS code G9934 should be billed:

1. A patient undergoes a colonoscopy, and a neoplasm is detected and diagnosed as a traditional serrated adenoma. The provider documents that the neoplasm does not involve cancer, and HCPCS code G9934 is used for billing.
2. During a routine screening, a sessile serrated polyp is found in the colon of a patient. The provider determines that the polyp does not involve cancer and uses HCPCS code G9934 for documentation and billing.
3. A patient undergoes a biopsy of a neoplasm, and the pathology report confirms that it is a sessile serrated adenoma. The provider documents that the neoplasm does not involve cancer and assigns HCPCS code G9934 for proper coding and billing.
4. During a colonoscopy, a traditional serrated adenoma is detected and diagnosed. The provider determines that the neoplasm does not involve cancer and uses HCPCS code G9934 for documentation and billing purposes.
5. A patient undergoes a polypectomy, and the removed polyp is identified as a sessile serrated polyp. The provider documents that the polyp does not involve cancer and assigns HCPCS code G9934 for accurate coding and billing.