Summary & Overview
HCPCS G9136: Non-Hodgkin Lymphoma, Transformed Disease Status
HCPCS Level II code G9136 captures a specific oncology classification event: documentation that non-Hodgkin's lymphoma has transformed from its original cellular diagnosis to a second cellular classification. The code is designated for use in a Medicare-approved demonstration project, indicating a focused policy or research context rather than routine billing across all payers. Nationally, clear coding for disease transformation in lymphoma matters for clinical tracking, eligibility for specific protocols, and alignment with demonstration project requirements.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what this code represents clinically and administratively, which payers are considered in the analysis, and where to look for further benchmarking or policy guidance. The publication summarizes the code's clinical context, typical site of service, and the relevance of demonstration-project designation. It also outlines available information and notes areas where input data are not provided. This summary aims to orient clinicians, coding professionals, and policy analysts to the role of HCPCS Level II code G9136 in documenting disease transformation for non-Hodgkin's lymphoma.
Billing Code Overview
HCPCS Level II code G9136 indicates a clinical oncology assessment documenting disease status for non-Hodgkin's lymphoma transformed from the original cellular diagnosis to a second cellular classification. This code is described for use within a Medicare-approved demonstration project and represents a diagnostic/status classification activity specific to oncology care.
Service type: Oncology disease status assessment / diagnostic classification review
Typical site of service: Oncology clinic or hospital outpatient setting, within the context of a demonstration project
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old male with a prior diagnosis of follicular lymphoma who presents for disease-status assessment after clinical progression with new B symptoms and rising lactate dehydrogenase. Tissue biopsy and pathology reveal histologic transformation to diffuse large B-cell lymphoma (transformation from the original cellular diagnosis). The patient is enrolled in a Medicare-approved demonstration project tracking disease-status classification changes in non-Hodgkin lymphomas. The clinical workflow includes evaluation by a hematology–oncology physician, staging imaging (PET/CT), diagnostic tissue confirmation with immunohistochemistry and molecular studies, multidisciplinary tumor board review, documentation of the transformed cellular classification in the medical record, and submission of the HCPCS Level II billing code G9136 for the disease-status classification change per project requirements. Typical sites of service include outpatient oncology clinics, hospital outpatient departments, and pathology laboratories supporting the demonstration project. Documentation elements required in the record include original and transformed histologic diagnoses, date of transformation, relevant pathology and molecular reports, imaging/staging summaries, and the physician’s clinical interpretation supporting the use of G9136 for project reporting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |