Summary & Overview
HCPCS G9823: Endometrial sampling or hysteroscopy with biopsy documented prior to ablation
HCPCS Level II code G9823 designates documentation that endometrial sampling or hysteroscopy with biopsy — including the diagnostic results — occurred within the 12 months prior to an endometrial ablation (exclusive of the ablation date). This code captures a preparatory diagnostic step that can affect clinical decision-making for uterine-preserving versus ablative approaches and supports appropriate prior evaluation before an ablative procedure. Nationally, consistent use of G9823 influences claims accuracy and quality reporting related to pre-procedural evaluation for endometrial ablation.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for G9823, typical sites of service, and which payers appear in national discussions of coverage and documentation. The publication outlines expected benchmarks and common billing considerations, summarizes policy implications for documentation and coding consistency, and provides clinical context for when endometrial sampling or hysteroscopy with biopsy is documented prior to ablation. Data not available in the input for specific payer edits, reimbursement rates, ICD-10 pairings, or associated taxonomies is noted as unavailable elsewhere in the report.
Billing Code Overview
HCPCS Level II code G9823 documents that an endometrial sampling or hysteroscopy with biopsy and results were completed and recorded within the 12 months prior to (but not including) the index date of an endometrial ablation. The service type is diagnostic endometrial evaluation with tissue sampling performed to inform management before an ablative procedure.
The typical site of service is an outpatient surgical or procedural setting, such as an ambulatory surgery center or hospital outpatient department, where endometrial sampling or hysteroscopy with biopsy is performed and pathology results are documented prior to subsequent endometrial ablation.
Clinical & Coding Specifications
Clinical Context
A 42-year-old woman presents to gynecology with heavy, irregular menstrual bleeding refractory to medical management. Prior to scheduling endometrial ablation, the gynecologist confirms an endometrial sampling (office endometrial biopsy) with pathology results documented within the previous 12 months. If sampling was inadequate or the patient has focal intrauterine pathology suspected, diagnostic hysteroscopy with directed biopsy was performed and results documented. The clinical workflow: initial evaluation and history, pelvic exam, pelvic ultrasound when indicated, office endometrial biopsy or hysteroscopy with biopsy, pathology processing and documentation in the chart, and then scheduling of endometrial ablation once benign or nonmalignant pathology is confirmed. Typical pre-procedure documentation includes indication for ablation (e.g., menorrhagia), date and result of the endometrial sampling or hysteroscopic biopsy within 12 months prior to the index ablation date, informed consent, and peri-procedural clearance as required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required for hysteroscopy or biopsy due to complexity documented in the record. |
23 |