Summary & Overview

HCPCS G9297: Shared Decision-Making, Conservative Therapy Not Documented

HCPCS Level II code G9297 flags instances where a clinician discussed conservative, non-surgical treatment options (for example, NSAIDs, analgesics, weight loss, exercise, injections) with a patient before a procedure but failed to document that shared decision-making or provide a reason for the missing documentation. Nationally, documentation gaps like this can affect quality measurement, prior authorization reviews, and claims adjudication. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication provides a concise overview of what G9297 represents, why it matters for clinical documentation and billing integrity, and what readers can expect regarding benchmarks and policy context. Readers will find: definitions and clinical context for shared decision-making in pre-procedure care; common sites of service and clinical scenarios where the code is relevant; an outline of how major payers handle documentation requirements and potential impacts on claim processing; and references to related billing and compliance topics. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9297HCPCS Level IIshared decision-makingpre-procedure counselingdocumentationnon-surgical therapyoutpatient surgerymedical billing

Billing Code Overview

HCPCS Level II code G9297 indicates a shared decision-making discussion where conservative (non-surgical) therapies — such as NSAIDs, analgesics, weight loss, exercise, and injections — were discussed prior to a procedure but documentation of that discussion is not present and no reason is given. This code reflects a communication or counseling element tied to pre-procedure care that is missing from the medical record.

Service Type: Pre-procedure counseling / shared decision-making

Typical Site of Service: Outpatient clinic or ambulatory surgical setting prior to a scheduled procedure

Data not available in the input for taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 58-year-old individual with chronic knee osteoarthritis who presents to an orthopedic clinic seeking evaluation for potential total knee arthroplasty. The clinician documents pain severity, functional limitations, prior conservative therapies, and imaging results. A formal shared decision-making conversation is expected to cover conservative (non-surgical) options such as NSAIDs, oral analgesics, weight loss, physical therapy/exercise programs, and intra-articular injections. The billing code G9297 applies when documentation does not record that this shared decision-making discussion occurred and no reason for omission is given. Typical workflow: initial assessment by an orthopedic surgeon or sports medicine physician, review of prior conservative care, discussion of risks/benefits and alternatives, documentation of patient preferences and final surgical plan. If the conversation is not documented, G9297 may be reported per payer policy during preoperative or consult encounters. Typical site of service is an outpatient clinic or preoperative evaluation center; the service type is shared decision-making / preoperative counseling and documentation capture. A realistic scenario: the patient had prior physical therapy and NSAID trials but the encounter note omits the detailed discussion of non-surgical alternatives; coder identifies absence of documentation and appends G9297 where payers permit.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When work required is substantially greater than typical and properly documented to justify additional payment.
`23`	Unusual anesthesia	When a procedure is performed under general anesthesia for clinical reasons that are unusual for the procedure.
`52`	Reduced services	When a service is partially reduced or not completed as planned and documentation supports reduction.
`53`	Discontinued procedure	When a procedure is started but discontinued due to extenuating circumstances or safety concerns.
`54`	Surgical care only	When only the surgical portion is performed and postoperative care is assigned to another provider.
`55`	Postoperative management only	When only postoperative care is furnished by the reporting practitioner.
`56`	Preoperative management only	When only preoperative care is provided by the reporting practitioner.
`62`	Two surgeons	When two surgeons work together as primary surgeons performing distinct parts of a procedure.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	When an eligible nonphysician assistant at surgery performs services per payer rules.
`QK`	Medical direction of two, three, or four certified registered nurse anesthetists (CRNAs)	When physician directs multiple CRNAs during anesthesia services.
`QX`	CRNA service with medical direction by physician	When a CRNA furnishes anesthesia under direction of a physician.
`QY`	Medical direction of one CRNA by physician	When physician directs a single CRNA's anesthesia care.
`FX`	Left foot, fourth digit or similar (site-specific, example)	Not typically used for shared decision-making; included from provided list but rarely applicable.
`FY`	Left foot, fifth digit or similar (site-specific, example)	Not typically used for shared decision-making; rarely applicable.

Taxonomy Code	Specialty	Notes
`208600000X`	Orthopedic Surgery	Primary specialty performing arthroplasty and preoperative shared decision-making for joint surgery.
`207X00000X`	Family Medicine	Frequently initiates conservative therapy and participates in shared decision-making for musculoskeletal complaints.
`207L00000X`	Sports Medicine	Manages nonoperative care (injections, rehab) and surgical referrals; documents conservative therapy discussions.
`207R00000X`	Physical Medicine & Rehabilitation	Oversees non-surgical management including exercise programs and pain management discussions.
`363A00000X`	Anesthesiology	Participates in preoperative evaluation and informed consent discussions when anesthesia considerations affect decision-making.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M17.0`	Bilateral primary osteoarthritis of knee	Common indication for knee arthroplasty; conservative treatments discussed prior to surgery.
`M17.11`	Unilateral primary osteoarthritis, right knee	Indicates localized degenerative joint disease prompting shared decision-making about nonoperative options.
`M17.12`	Unilateral primary osteoarthritis, left knee	Same clinical relevance for left-sided knee disease.
`M19.011`	Primary osteoarthritis, right shoulder	Degenerative joint disease where conservative care (injections, therapy) is often attempted before surgery.
`M54.5`	Low back pain	Back pain may be managed conservatively; shared decision-making is relevant when considering invasive procedures.
`M75.51`	Bursitis of right shoulder	Conservative measures like injections and physical therapy are standard prior to surgical interventions.
`M23.2`	Derangement of meniscus due to old tear or injury	Meniscal pathology where non-surgical management may be discussed before arthroscopic or open surgery.
`M51.36`	Other intervertebral disc degeneration, lumbar region	Degenerative disc conditions where conservative therapies are commonly discussed before operative care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99204`	Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity	Used for comprehensive evaluation when discussing surgical options and conservative therapy prior to a surgical referral.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Common follow-up visit type where shared decision-making discussions and documentation occur.
`20610`	Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee)	Represents a conservative treatment option (injection) often discussed as part of shared decision-making.
`97110`	Therapeutic exercises to develop strength, endurance, range of motion and flexibility	Physical therapy intervention commonly recommended as conservative care prior to considering surgery.
`27130`	Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty)	Example definitive surgical procedure for which preoperative shared decision-making about conservative therapy is relevant.
`27447`	Arthroplasty, knee, condyle and plateau; medial and lateral compartments with or without patellar resurfacing (total knee arthroplasty)	Definitive surgical procedure frequently preceded by shared decision-making regarding non-surgical alternatives.