How To Use HCPCS Code G9998

HCPCS code G9998 describes the documentation of medical reasons for an interval of less than 3 years since the last colonoscopy. This code is used to indicate situations where the previous colonoscopy was incomplete, had inadequate preparation, or involved the piecemeal removal of adenomas or sessile serrated polyps that were 20 mm or larger in size. It is also used when the last colonoscopy revealed more than 10 adenomas, lower gastrointestinal bleeding, or when the patient is at high risk for colon cancer due to underlying medical conditions such as Crohn’s disease, ulcerative colitis, personal or family history of colon cancer, or hereditary colorectal cancer syndromes.

1. What is HCPCS G9998?

HCPCS code G9998 is a specific code used in medical coding to identify and document the medical reasons for an interval of less than 3 years since the last colonoscopy. It helps healthcare providers accurately report and track the need for a repeat colonoscopy based on specific clinical indications.

2. Official Description

The official description of HCPCS code G9998 is “Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history [i.e. Crohn’s disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes]).” The short description is “Doc med rsn <3 colon."

3. Procedure

  1. Review the patient’s medical history and previous colonoscopy reports.
  2. Identify the specific medical reasons for the interval of less than 3 years since the last colonoscopy.
  3. Document the reasons clearly and accurately in the patient’s medical record.
  4. Ensure that the documentation includes details such as incomplete previous colonoscopy, inadequate preparation, piecemeal removal of adenomas or sessile serrated polyps of 20 mm or larger, more than 10 adenomas found in the last colonoscopy, lower gastrointestinal bleeding, or the patient being at high risk for colon cancer due to underlying medical conditions.
  5. Code the encounter using HCPCS code G9998 to indicate the documentation of medical reasons for the interval of less than 3 years since the last colonoscopy.

4. When to use HCPCS code G9998

HCPCS code G9998 should be used when there is a need to document the medical reasons for an interval of less than 3 years since the last colonoscopy. This code is applicable in various situations, including when the previous colonoscopy was incomplete, had inadequate preparation, or involved the removal of adenomas or sessile serrated polyps of a certain size. It is also used when more than 10 adenomas were found in the last colonoscopy, there was lower gastrointestinal bleeding, or the patient is at high risk for colon cancer due to underlying medical conditions.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9998, healthcare providers need to ensure that the documentation clearly supports the medical reasons for the interval of less than 3 years since the last colonoscopy. The medical record should include detailed information about the previous colonoscopy, the specific reasons for the interval, and any relevant clinical findings. It is important to accurately code the encounter using G9998 to ensure proper reimbursement and compliance with coding guidelines.

6. Historical Information and Code Maintenance

HCPCS code G9998 was added to the Healthcare Common Procedure Coding System on January 01, 2022. It has an effective date of January 01, 2024, indicating that it can be used for reporting services on or after that date. As of now, there have been no maintenance actions taken for this code, as indicated by the action code C, which means a change in the long description of the procedure or modifier code.

7. Medicare and Insurance Coverage

HCPCS code G9998 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This indicates that the reimbursement for this code may be bundled or included in other services provided during the encounter. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS G9998 is not priced separately by Part B or the value is not established.

8. Examples

Here are some examples of when HCPCS code G9998 should be billed:

  1. A patient with a history of Crohn’s disease who had an incomplete colonoscopy in the previous year.
  2. A patient with a family history of colon cancer who had inadequate preparation for the last colonoscopy.
  3. A patient with a personal history of colon cancer who had piecemeal removal of adenomas in the last colonoscopy.
  4. A patient with lower gastrointestinal bleeding who had a previous colonoscopy within the past 2 years.
  5. A patient with hereditary colorectal cancer syndrome who had more than 10 adenomas found in the last colonoscopy.

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