HCPCS G9360: No Documentation of Negative or Managed Positive TB Screen - OpenPayer

Summary & Overview

HCPCS G9360: No Documentation of Negative or Managed Positive TB Screen

HCPCS Level II code G9360 denotes absence of documented evidence for a negative or managed positive tuberculosis (TB) screening result. Nationally, accurate documentation of TB screening status is important for infection control, public health reporting, and continuity of care across ambulatory and outpatient settings. Use of this code signals gaps in record-keeping that can affect quality measurement and care coordination.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the clinical and administrative contexts in which it appears, and the implications for billing workflows and quality reporting. The publication outlines common modifiers associated with the service line, typical sites of service, and notes on data availability where input elements were not provided.

This summary equips billing managers, compliance officers, and clinicians with the informational context needed to interpret occurrences of G9360 in claims streams and administrative records, and to align documentation practices with payer and public health expectations.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9360HCPCS Level IITB screeningdocumentationoutpatientquality measurementbilling compliancepublic healthadministrative code

Billing Code Overview

HCPCS Level II code G9360 indicates no documentation of a negative or managed positive tuberculosis (TB) screen. The description implies the service relates to TB screening documentation and the code is used to flag missing or incomplete documentation of TB screening results.

Service Type: Documentation/Screening administrative flag related to TB screening

Typical Site of Service: Outpatient clinic or other ambulatory care setting where TB screening and documentation are expected

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult or pediatric patient presenting for routine occupational health screening, pre-employment clearance, or intake to a congregate living facility who requires tuberculosis (TB) screening documentation. During the visit, a clinician documents that a TB screening was performed using either a symptom assessment, tuberculin skin test (TST), interferon-gamma release assay (IGRA) such as QuantiFERON, or prior documented TB test results. The billing code G9360 denotes absence of documentation of a negative TB screen or confirmation that a previously positive TB screen is being actively managed. In the clinical workflow the medical assistant or nurse performs the initial screening questionnaire and places or documents the result of a TST or orders an IGRA; the provider reviews results and documents interpretation and plan. If the chart lacks explicit documentation of a negative result or a documented management plan for a known positive result, G9360 is used to indicate missing required documentation for TB screening status. Typical sites of service include outpatient primary care clinics, occupational health clinics, urgent care centers, student health clinics, and pre-admission or long-term care intake clinics. Common patient presentations include new employee health clearance, school or camp entry screening, pre-operative clearance, or intake to correctional or congregate-living settings where proof of negative TB screening or active management of latent/active TB is required.

Coding Specifications

Modifier	Description	When to Use

HCPCS G0501: Resource-Intensive E/M Visit With Mobility-Assistive Technology

HCPCS-LEVEL-II-G8509-POSITIVE-PAIN-ASSESSMENT-NO-FOLLOW-UP-PLAN

HCPCS Level II G8509: Positive Pain Assessment, No Follow-Up Plan

HCPCS-G3003-CHRONIC-PAIN-MANAGEMENT-ADDITIONAL-15-MIN

HCPCS G3003: Additional 15 Minutes of Chronic Pain Management

HCPCS-G8630-PERIOPERATIVE-PROPHYLACTIC-ANTIBIOTIC-TIMING

HCPCS G8630: Perioperative Prophylactic Parenteral Antibiotic Timing

HCPCS-G8768-MEDICAL-REASON-NO-LIPID-PROFILE

HCPCS G8768: Medical Reason for Not Performing Lipid Profile

HCPCS-G9754-INCIDENTAL-PULMONARY-NODULE

HCPCS G9754: Incidental Pulmonary Nodule, Imaging Finding

HCPCS-G8753-SYSTOLIC-BP-GE-140-MMHG

HCPCS G8753: Most Recent Systolic Blood Pressure ≥ 140 mmHg

HCPCS-G0472-HEPATITIS-C-ANTIBODY-SCREENING-HIGH-RISK

HCPCS G0472: Hepatitis C Antibody Screening for High-Risk Individuals

HCPCS-G8405-LOWER-EXTREMITY-NEUROLOGICAL-EXAM-NOT-PERFORMED

HCPCS G8405: Lower Extremity Neurological Exam Not Performed

HCPCS-G8863-PATIENT-NOT-ASSESSED-BONE-LOSS

HCPCS G8863: Patients Not Assessed for Risk of Bone Loss

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`208000000X`	Family Medicine	Primary providers who perform occupational and routine TB screening and document results.
`207Q00000X`	Internal Medicine	Adult primary care physicians performing TB screening and pre-admission clearance.
`363LF0000X`	Public Health	Public health clinicians who oversee community and congregate-setting TB screening programs.
`163W00000X`	Occupational Medicine	Occupational health clinicians responsible for pre-employment and work-related TB screening.
`207L00000X`	Infectious Disease	Specialists who manage positive TB screens and document treatment plans when required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R76.11`	Nonspecific reaction to TB test without active disease	Indicates a positive TB test reaction that requires management and documentation to avoid `G9360` if managed and recorded.
`Z11.1`	Encounter for screening for respiratory tuberculosis	Directly related to TB screening encounters where documentation of a negative screen is expected.
`Z20.0`	Contact with and (suspected) exposure to tuberculosis	Relevant when asymptomatic exposed individuals require testing and documentation.
`Z00.6`	Encounter for examination for normal comparison and control in clinical research (used here as general pre-employment or pre-placement exam)	Used for routine health clearance encounters where TB screening documentation is performed.
`B20`	Human immunodeficiency virus [HIV] disease	HIV-positive patients have higher TB risk; documentation of screening status is clinically important.
`A15.0`	Tuberculosis of lung, confirmed by sputum microscopy with culture	Active TB diagnosis requiring active management documentation, which if present would negate `G9360` applicability.
`Z79.3`	Long-term (current) use of antimicrobial agents	Relevant when patients are on treatment for latent TB infection and documentation of management is required.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`86580`	Tuberculin skin test, intradermal; purified protein derivative (PPD) injection and interpretation within 48-72 hours	Commonly performed before or with documentation requirements; a recorded negative TST result is relevant to avoiding `G9360`.
`86480`	Interferon gamma release assay (e.g., QuantiFERON)	Laboratory-based TB screening test often ordered instead of TST; result documentation substitutes for a negative screen.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Typical office visit code during which TB screening is reviewed and documented.
`99058`	Home visit for blood drawing (example) — Data not available in the input.	Data not available in the input.
`G0438`	Annual wellness visit, initial	May include review of preventive screening status including TB; documentation of negative screen is recorded during such encounters.

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