Summary & Overview
HCPCS G9093: Rectal Cancer Disease-Status Assessment, t4 any n m0
HCPCS Level II code G9093 records a disease-status assessment for rectal cancer restricted to invasive adenocarcinoma where initial staging was t4, any n, m0, and there is no evidence of progression, recurrence, or metastasis. The code is intended for use in a Medicare-approved demonstration project and is relevant for documenting baseline extent of disease prior to neo-adjuvant therapy when applicable. Nationally, precise documentation of disease status supports appropriate oncology care planning, clinical trial and demonstration reporting, and payer determinations related to covered oncology services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when G9093 is used, the typical service setting, and the implications for documentation in demonstration-project reporting. The publication provides benchmarks and policy-oriented commentary on coding utility in oncology case capture, clarifies the clinical population described by the code, and outlines areas where payers commonly review records for concordance with the code description.
Billing Code Overview
HCPCS Level II code G9093 describes a disease-status assessment for rectal cancer, limited to invasive cancer with adenocarcinoma as the predominant cell type. The code documents that the extent of disease was initially established as t4, any n, m0 prior to any neo-adjuvant therapy (if given) and that there is no evidence of disease progression, recurrence, or metastases. This code is designated for use in a Medicare-approved demonstration project.
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Service type: Oncology disease-status assessment
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Typical site of service: Oncology clinic or hospital outpatient setting
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a newly diagnosed rectal adenocarcinoma presents for enrollment in a Medicare-approved demonstration project tracking disease status. Initial staging prior to any neo-adjuvant therapy documents tumor invading through the visceral peritoneum or into adjacent structures consistent with T4, nodal status variable (any N), and no distant metastasis (M0). The clinical workflow begins with history and physical, colonoscopy with biopsy confirming adenocarcinoma, baseline pelvic MRI and CT chest/abdomen/pelvis for staging, and multidisciplinary tumor board review. The patient may undergo neoadjuvant chemoradiation followed by restaging; for demonstration project reporting, the case is coded to indicate initial extent of disease as t4, any n, m0 with no evidence of progression, recurrence, or metastases. Typical sites of service include outpatient oncology clinics, hospital-based cancer centers, and multidisciplinary specialty clinics where staging, treatment planning, and demonstration project data capture occur. Common patient encounters include initial diagnostic staging visit, pre-treatment planning, and periodic disease-status reporting visits required by the demonstration project protocol.
Coding Specifications
| Modifier | Description | When to Use |
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