Summary & Overview
HCPCS G9822: Endometrial Ablation Within Prior 12 Months
HCPCS Level II code G9822 denotes that a patient underwent an endometrial ablation within the 12 months prior to the index date (excluding the index date). The code is a clinical marker used in claims and quality workflows to identify recent ablative treatment of the endometrium, which can affect subsequent management and coding for gynecologic services. Nationally, tracking prior endometrial ablation is relevant for quality measurement, utilization review, and care coordination for patients with abnormal uterine bleeding or related gynecologic conditions.
Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication explains how G9822 is used in claims contexts, summarizes typical sites of service and clinical context, and outlines what readers will learn about benchmarks, policy considerations, and documentation expectations. Where input data is unavailable, the text notes that explicitly.
Readers will find concise benchmarks for common use cases, discussion of policy and billing implications at a national level, and clinical context relevant to providers, coders, and payers. The content aims to clarify the role of G9822 in administrative workflows and quality measurement without providing clinical or billing recommendations.
Billing Code Overview
HCPCS Level II code G9822 identifies patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date). This code is used to flag prior endometrial ablation as a patient history element for clinical review, quality measurement, or claims processing.
Service Type: Gynecologic procedure history / prior surgical procedure
Typical Site of Service: Outpatient surgical center or hospital outpatient department, where endometrial ablation procedures are commonly performed.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 38-year-old woman with a history of heavy menstrual bleeding underwent hysteroscopic endometrial ablation nine months prior to presentation. She now presents to a gynecology clinic for follow-up and evaluation of persistent pelvic discomfort and irregular bleeding. The clinical workflow includes review of the prior operative note to confirm the ablation procedure, focused history and pelvic exam, pregnancy test if of childbearing potential, transvaginal ultrasound if retained tissue or endometrial thickness is a concern, and counseling regarding additional management options (medical therapy, repeat ablation, or hysterectomy). Documentation should note the prior endometrial ablation date, technique (e.g., thermal, radiofrequency, or resectoscopic), any perioperative complications, and current symptoms. For billing and quality reporting, the presence of an endometrial ablation within the prior 12 months (exclusive of the index date) is the key trigger for code G9822.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required for the service due to complexity related to prior ablation scarring or adhesions. |
23 |