How To Use HCPCS Code G9937

HCPCS code G9937 describes a diagnostic colonoscopy procedure. In this article, we will explore the details of this code, 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 G9937?

HCPCS code G9937 is used to identify a diagnostic colonoscopy procedure. It is important to note that this code specifically refers to the diagnostic aspect of the colonoscopy, rather than any therapeutic interventions that may be performed during the procedure.

2. Official Description

The official description of HCPCS code G9937 is “Diagnostic colonoscopy.” This code is used to indicate that the purpose of the colonoscopy is for diagnostic purposes, such as the evaluation of gastrointestinal symptoms or the detection of abnormalities within the colon.

3. Procedure

1. The provider begins by preparing the patient for the colonoscopy procedure, which may involve dietary restrictions and bowel preparation.
2. The patient is typically placed under sedation or anesthesia to ensure comfort during the procedure.
3. A flexible tube called a colonoscope is inserted through the rectum and advanced into the colon.
4. The colonoscope is equipped with a light and a camera, allowing the provider to visualize the inside of the colon on a monitor.
5. The provider carefully examines the entire length of the colon, looking for any abnormalities, such as polyps, tumors, or inflammation.
6. If any suspicious areas are identified, the provider may perform additional procedures, such as taking biopsies or removing polyps.
7. Once the examination is complete, the colonoscope is slowly withdrawn, and the procedure is concluded.

4. When to use HCPCS code G9937

HCPCS code G9937 should be used when the primary purpose of the colonoscopy is for diagnostic evaluation. This code is not appropriate for therapeutic interventions, such as polyp removal or treatment of gastrointestinal bleeding. It is essential to accurately document the reason for the colonoscopy and ensure that it aligns with the diagnostic intent of this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9937, healthcare providers need to document the medical necessity for the diagnostic colonoscopy. This may include the patient’s symptoms or indications that prompted the procedure, as well as any relevant medical history. Additionally, providers should ensure that the documentation supports the use of this specific code and accurately reflects the diagnostic nature of the colonoscopy.

6. Historical Information and Code Maintenance

HCPCS code G9937 was added to the Healthcare Common Procedure Coding System on January 1, 2018. It has an effective date of January 1, 2021. As of this effective date, the code is no longer active and has been terminated. The termination of this code indicates that it is no longer valid for billing purposes.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G9937 may vary. It is important to consult the specific guidelines and policies of the payer to determine if this code is payable. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare or other insurers.

8. Examples

Here are five examples of scenarios where HCPCS code G9937 may be billed:

1. A patient presents with chronic abdominal pain, and a diagnostic colonoscopy is performed to evaluate the cause of the symptoms.
2. A patient with a family history of colon cancer undergoes a routine screening colonoscopy, during which a suspicious lesion is identified and biopsied.
3. A patient with a history of inflammatory bowel disease requires a surveillance colonoscopy to monitor disease activity and detect any potential complications.
4. A patient experiences unexplained rectal bleeding, and a diagnostic colonoscopy is performed to identify the source of the bleeding.
5. A patient with a positive fecal occult blood test undergoes a diagnostic colonoscopy to investigate the presence of any underlying gastrointestinal pathology.