Summary & Overview
HCPCS G9088: Colon Cancer, Adenocarcinoma, Disease Status (m1, No Evidence of Disease)
HCPCS Level II code G9088 designates a disease-status classification for colon cancer patients with invasive adenocarcinoma who are m1 at diagnosis, metastatic, locally recurrent, or progressive, but who currently have no clinical, radiologic, or biochemical evidence of disease. The code is specified for use in Medicare-approved demonstration projects and supports consistent reporting of disease status in research or pilot program settings. Nationally, standardized disease-status coding aids comparisons across participating sites and informs program evaluation.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for the code, typical sites of service where it is reported, and the implications for documentation in demonstration projects. The publication summarizes benchmarking considerations, reporting expectations in demonstration settings, and related billing and coding context where available.
This summary is for national audiences and focuses on the code's purpose, clinical scope, and reporting environment rather than specific state-level policies or provider recommendations. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G9088 describes an oncology disease status designation for colon cancer, limited to invasive cancer with adenocarcinoma as the predominant cell type. The code applies when the disease is m1 at diagnosis, metastatic, locally recurrent, or progressive but with no current clinical, radiologic, or biochemical evidence of disease. The description specifies use in a Medicare-approved demonstration project, indicating a research or pilot program context for reporting disease status.
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Service type: Oncology disease status assessment and reporting for colon cancer in the context of a demonstration project
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Typical site of service: Oncology clinics, hospital outpatient departments, or other clinical settings participating in Medicare demonstration projects
Clinical & Coding Specifications
Clinical Context
A 64-year-old patient with a prior history of stage IV colon adenocarcinoma (predominant cell type adenocarcinoma) presents for enrollment and data collection in a Medicare-approved oncology demonstration project assessing disease status. At initial metastatic diagnosis the patient had distant liver metastases (M1) and has since undergone systemic chemotherapy with surgical resection of the primary tumor. At the current visit there is no clinical, radiologic, or biochemical evidence of active disease. The clinical workflow includes: obtaining a focused oncology history (prior treatments, dates of diagnosis, prior metastases), review of recent imaging and tumor markers, physical exam focused on recurrence, documentation of disease-free status for the demonstration project, abstraction of pertinent prior pathology and operative reports, and completion of study-specific reporting forms. Ancillary services commonly include ordering surveillance labs and imaging as indicated, coordination with oncology nursing and data managers for project enrollment, and coding/billing staff applying G9088 to indicate disease status classification for colon cancer within the demonstration project parameters.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no modifier is applicable and claim is submitted without special circumstances. |