In simple words: This code is used for patients with rectal cancer who are part of a special Medicare project. It tells the doctor about the cancer's current state: it's invasive, mostly a type called adenocarcinoma, hasn't spread to distant organs, and is at stage T4. This information is recorded before any treatment to shrink the tumor is given, and there are no signs the cancer has come back or gotten worse.

This code reports the current disease status of a patient's rectal cancer as part of a Medicare-approved demonstration project. The cancer is limited to invasive, predominantly adenocarcinoma. The initial extent of the disease is classified as primary tumor category T4, any lymph node category (N), and metastasis category M0 (no distant metastasis) before any neoadjuvant therapy. There is no evidence of disease progression, recurrence, or metastases.

Example 1: A patient with newly diagnosed rectal cancer undergoes staging and is determined to have a T4, N2, M0 tumor before any neoadjuvant therapy. This code (G9093) would be reported along with the appropriate codes for the primary focus of the visit and adherence to practice guidelines., A patient with rectal cancer initially staged at T4, N1, M0 has completed neoadjuvant therapy and is now being evaluated for surgery. G9093 would not be reported in this scenario as the code specifically applies to the status *before* neoadjuvant therapy. A different code related to post-neoadjuvant therapy status would be appropriate., A patient with rectal cancer is enrolled in the demonstration project and has an initial diagnosis of T3, N0, M0. After completing neoadjuvant chemotherapy, the tumor has shrunk, and a subsequent CT scan shows no evidence of distant metastasis. While there is no disease progression, G9093 wouldn't apply because the initial stage was T3, not T4.

Documentation should include detailed clinical notes regarding the patient's rectal cancer diagnosis, including the initial stage determined by clinical and radiological findings before any neoadjuvant therapy. Pathology reports confirming adenocarcinoma should be present. Records must confirm the patient’s participation in the Medicare demonstration project and their non-enrollment in a Medicare Advantage plan.