Summary & Overview
HCPCS G9253: Adenoma or Neoplasm Not Detected on Screening Colonoscopy
HCPCS Level II code G9253 is used to document that adenoma(s) or other neoplasm were not detected during a screening colonoscopy. As a code reflecting a negative screening exam, it is important for quality measurement, claims processing, and clinical documentation related to colorectal cancer screening programs nationwide. The code clarifies that the encounter was a screening colonoscopy with no neoplastic findings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns where available, typical sites of service, and clinical context for use of the code. The publication also outlines benchmarks and reporting considerations relevant to screening colonoscopy quality measures and claims submission.
The report is intended to help billing, coding, and compliance staff understand the clinical meaning of the code, its role in screening workflows, and where it fits within payer reporting and quality programs. Data not available in the input will be identified explicitly in the detailed sections.
Billing Code Overview
HCPCS Level II code G9253 indicates that adenoma(s) or other neoplasm were not detected during a screening colonoscopy. This code documents a negative screening colonoscopy exam for neoplastic lesions.
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Service type: Screening colonoscopy
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Typical site of service: Ambulatory surgical center or hospital outpatient department where colonoscopic screening procedures are performed
Clinical & Coding Specifications
Clinical Context
A 58-year-old average-risk patient presents for a screening colonoscopy performed in an ambulatory endoscopy center. The gastroenterologist completes a full colonoscopic exam to the cecum with mucosal inspection. No polyps, adenomas, or other neoplastic lesions are identified during the procedure. Biopsy is not indicated because no suspicious lesions are seen. The endoscopy report documents indication as routine colorectal cancer screening, informed consent, bowel preparation quality, cecal intubation, and absence of adenomas or other neoplasms. The clinical workflow includes pre-procedure assessment, anesthesia or monitored sedation, the colonoscopy procedure, post-anesthesia recovery, and documentation of findings and recommended interval for repeat screening based on guidelines and patient risk factors. Typical site of service is an ambulatory surgical center or hospital outpatient department for a screening colonoscopy visit. Payor adjudication for a screening exam may involve explanation of benefits distinguishing screening versus diagnostic or polypectomy services for payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a distinct E/M visit is provided on the same date as the colonoscopy for a separate problem. |