Summary & Overview
HCPCS G9086: Colon Cancer Disease Status, Adenocarcinoma Predominant
HCPCS Level II code G9086 documents the disease status of colon cancer specifically limited to invasive disease with adenocarcinoma as the predominant cell type and initial staging of T1-4, N1-2, M0 with no evidence of progression, recurrence, or metastases. The code is intended for use within a Medicare-approved demonstration project and is relevant to oncology providers, hospital outpatient departments, and payers monitoring demonstration program utilization. Nationally, precise disease-status coding supports quality measurement, care coordination, and evaluation of demonstration initiatives for colorectal cancer management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the code, guidance on typical service setting and purpose, and an outline of what to expect in payer coverage discussions and benchmarking. The publication addresses how G9086 is used to represent initial disease extent without progression or metastasis, and summarizes implications for documentation and claims when participating in Medicare demonstration projects.
Data not available in the input: specific payer policy language, associated taxonomies, ICD-10 diagnosis crosswalks, related codes, and detailed service-line mapping.
Billing Code Overview
HCPCS Level II code G9086 indicates oncology disease status for colon cancer limited to invasive cancer where adenocarcinoma is the predominant cell type. The description specifies that the extent of disease is initially established as T1-4, N1-2, M0 with no evidence of disease progression, recurrence, or metastases. This code is designated for use in a Medicare-approved demonstration project.
Service type: Oncology disease status assessment and documentation.
Typical site of service: Oncology clinic or hospital outpatient setting, where staging and disease-status evaluations for colon cancer are performed.
Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of invasive colorectal adenocarcinoma presents to a Medicare-approved demonstration project clinic for disease-status evaluation after initial staging and definitive surgical resection with lymphadenectomy. Prior pathology established tumor stage T2N1M0 (one to two regional lymph nodes positive) and adenocarcinoma as the predominant histology. Current evaluation focuses on confirming continued absence of progression, recurrence, or distant metastases (no new lesions on cross-sectional imaging and negative surveillance carcinoembryonic antigen trend). The clinical workflow includes: pre-visit chart review of prior operative and pathology reports; focused history and physical to assess symptoms (bowel habit change, weight loss, pain); ordering or review of surveillance imaging (CT chest/abdomen/pelvis or MRI as clinically indicated) and laboratory markers; multidisciplinary tumor board discussion if any concern arises; documentation of disease status as stable (t1-4, n1-2, m0) with no evidence of progression; and completion of Medicare demonstration project documentation and submission of the HCPCS Level II billing code G9086 for disease-status reporting in the demonstration context. Typical sites of service are outpatient oncology clinics, hospital-based outpatient departments, and academic cancer centers participating in the demonstration project. Typical patient scenario: surveillance visit for a post-resection colon cancer patient with prior invasive adenocarcinoma, clinically asymptomatic, imaging unchanged from prior baseline, and plan for routine follow-up surveillance without additional therapy.
Coding Specifications
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