Summary & Overview
HCPCS G9496: Documentation of No Adenoma or Other Neoplasm
HCPCS Level II code G9496 documents the clinical reason for not detecting adenoma(s) or other neoplasm during colorectal evaluation, including cases where a lesion is characterized only as a traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma. Nationally, clear documentation of screening and surveillance findings affects quality reporting, clinical follow-up recommendations, and coding consistency across payers. Accurate use of G9496 helps distinguish absence of conventional adenomas from findings limited to serrated lesions, which has implications for surveillance intervals and quality measurement.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides clinicians and billing staff with benchmarks for use rates, summarizes relevant policy and coding guidance where available, and outlines clinical context for when G9496 is applicable. Readers will learn how the code is intended to be applied in documentation, common scenarios that trigger its use, and how its application interacts with colorectal screening and surveillance workflows. Data not available in the input for specific payer policies, modifier use, associated taxonomies, ICD-10 pairings, and related codes is noted where applicable.
Billing Code Overview
HCPCS Level II code G9496 documents the reason for not detecting adenoma(s) or other neoplasm following colorectal evaluation. The descriptor notes examples where the neoplasm is diagnosed only as a traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma.
Service type: Colorectal pathology/colonoscopy-related documentation
Typical site of service: Endoscopy suite or outpatient surgical center
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents for surveillance colonoscopy after a prior screening found serrated polyps. During colonoscopy, no conventional adenoma or invasive neoplasm is identified, but pathology returns a lesion diagnosed as a sessile serrated polyp. The endoscopy report must document the clinical reason why no adenoma(s) or other conventional neoplasm were detected — for example, that the only neoplastic finding is a serrated lesion (traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma) rather than an adenomatous polyp. The clinical workflow includes: pre-procedure indication and consent, performance of diagnostic and therapeutic colonoscopy with lesion sampling or removal, pathology review confirming serrated lesion type, and final documentation in the endoscopy and pathology reports stating the rationale for absence of adenoma(s) or other neoplasm (e.g., diagnosis limited to serrated pathway lesions). Typical site of service is an outpatient endoscopy suite or ambulatory surgical center where gastrointestinal specialists perform colonoscopy and submit HCPCS Level II code G9496 to indicate documentation of reason for not detecting adenoma(s) or other neoplasm.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when a distinct E/M visit is performed and documented on the same day as the colonoscopy |