Summary & Overview
HCPCS G9092: Rectal Cancer Disease Status, t1-3 n1-2 m0
HCPCS Level II code G9092 identifies a disease-status entry for rectal cancer limited to invasive adenocarcinoma with staging established as t1-3, n1-2, m0 prior to neo-adjuvant therapy. The code is designated for use within a Medicare-approved demonstration project and captures documentation that there is no evidence of progression, recurrence, or metastases. Nationally, precise staging and disease-status reporting are critical for oncology care coordination, eligibility for protocols, and quality measurement.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise understanding of clinical context and intended use, guidance on common billing modifiers (as provided), and where this code sits in oncology service lines. The analysis outlines expected sites of service, the role of the code in documenting baseline disease extent prior to neo-adjuvant therapy, and practical implications for coding consistency in demonstration-project settings.
This publication is intended to help clinical coders, oncology administrators, and policy analysts understand the purpose of HCPCS Level II code G9092, the clinical scenario it represents, and the payer landscape relevant for national program and demonstration project reporting.
Billing Code Overview
HCPCS Level II code G9092 documents disease status for rectal cancer limited to invasive adenocarcinoma with initial extent of disease established as t1-3, n1-2, m0 prior to any neo-adjuvant therapy, with no evidence of progression, recurrence, or metastases. This code is specified for use in a Medicare-approved demonstration project and is focused on staging/status reporting rather than direct treatment delivery.
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Service type: Oncology disease-status/staging assessment
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Typical site of service: Hospital outpatient departments or oncology clinics where initial staging and follow-up assessment occur
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with biopsy-confirmed rectal adenocarcinoma undergoes staging and disease-status documentation for enrollment in a Medicare-approved demonstration project. Initial diagnostic workup demonstrates an invasive adenocarcinoma limited to the rectum with clinical staging prior to any neo-adjuvant therapy of T1-3, N1-2, M0. The multidisciplinary workflow includes colorectal surgery, medical oncology, radiation oncology, and radiology: imaging (pelvic MRI and CT chest/abdomen), endoscopic assessment (flexible sigmoidoscopy or colonoscopy with tumor measurement), and pathology review to confirm adenocarcinoma as the predominant histology. The treating team documents no evidence of disease progression, recurrence, or distant metastases at the time of determination. This service is recorded to establish baseline disease status for program reporting and longitudinal outcome tracking in the demonstration project.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default or unspecified modifier | Rarely appended; use only if payer requires a two-character modifier when no other modifier applies |
22 |