2025 HCPCS code G9420

Pathology report indicating a lung cancer specimen from a site other than the lung or not classified as primary non-small cell lung cancer (NSCLC).

Refer to the most current HCPCS coding guidelines for correct application.

The medical necessity of code G9420 is established by the need to clarify the diagnosis of suspected lung cancer through appropriate pathological analysis of tissue samples obtained during a biopsy or cytological examination. In cases where the pathology report shows the specimen is not primary NSCLC or originated from a site other than the lung, this code reflects the findings and allows for appropriate billing.

Pathologist

In simple words: This code is used when a pathology test for lung cancer shows the sample wasn't from the lung or isn't a main type of lung cancer.The results don't tell doctors the exact kind of lung cancer, which is important for treatment planning.

A pathology report for a biopsy specimen, cytology specimen, or both indicates a diagnosis other than primary NSCLC or a site other than the lung.The report does not provide a specific NSCLC histologic type (e.g., squamous cell carcinoma, adenocarcinoma).Alternatively, the report may classify the specimen as NSCLC NOS (not otherwise specified) with an explanation. Determining the histology type is crucial for predicting patient response to therapies.

Example 1: A patient undergoes a lung biopsy, and the pathology report reveals the tissue sample is not consistent with primary non-small cell lung cancer. The tissue shows features of another type of cancer or an inflammatory process. G9420 is used., A cytology study of a lung fluid sample reveals malignant cells, but the location and type of cancer cannot be definitively determined. The pathology report states the cells are consistent with malignancy but not primary NSCLC.G9420 is used., A patient presents with symptoms suggestive of lung cancer.A biopsy is performed, and the pathology report indicates that the specimen was taken from a lymph node near the lung and shows metastasis from an unknown primary cancer source.G9420 is appropriate.

* Complete pathology report detailing the specimen source, microscopic findings, and diagnostic conclusions.* Clinical notes documenting the patient's symptoms, medical history, and reasons for the biopsy or cytology testing.* Imaging reports (e.g., CT scan, X-ray) supporting the clinical suspicion of lung cancer or providing evidence of the location of the sampled tissue.

** This code is specifically for situations where the pathology report definitively excludes a primary diagnosis of non-small cell lung cancer or indicates the specimen originated from a site other than the lung. It's essential to accurately reflect the findings of the pathology report when selecting this code. This is different from a case where NSCLC cannot be definitively ruled out.

  • Payment Status: Active
  • Specialties:Pathology, Oncology, Pulmonology
  • Place of Service:Hospital, Outpatient clinic, Physician's office, Ambulatory surgical center
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