How To Use HCPCS Code A9503

HCPCS code A9503 describes the diagnostic use of Technetium tc-99m medronate, per study dose, up to 30 millicuries. This code is used to identify the specific radiopharmaceutical used in diagnostic imaging procedures. In this article, we will explore the official description, procedure, when to use the code, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS A9503?

HCPCS code A9503 is used to identify the diagnostic use of Technetium tc-99m medronate. This radiopharmaceutical is commonly used in bone scans to detect abnormalities in the skeletal system. It is administered as a study dose, with a maximum activity of 30 millicuries.

2. Official Description

The official description of HCPCS code A9503 is “Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries.” The short description for this code is “Tc99m medronate.”

3. Procedure

1. The procedure for HCPCS code A9503 involves the administration of Technetium tc-99m medronate to the patient.
2. The radiopharmaceutical is typically injected intravenously.
3. After the injection, the patient is allowed to rest for a specific period to allow the radiopharmaceutical to distribute throughout the body.
4. Once the distribution phase is complete, the patient undergoes imaging using a gamma camera or other appropriate imaging equipment.
5. The images obtained help in the diagnosis and evaluation of various bone conditions, such as fractures, infections, tumors, and metastatic disease.

4. When to use HCPCS code A9503

HCPCS code A9503 is used when performing diagnostic bone scans using Technetium tc-99m medronate. This code should be used when the study dose does not exceed 30 millicuries. It is important to follow the specific guidelines and eligibility criteria set by the payer or insurance company when using this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9503, healthcare providers need to document the administration of Technetium tc-99m medronate, the dosage used (up to 30 millicuries), and the specific diagnostic imaging procedure performed. It is essential to include all relevant information in the medical record to support the medical necessity of the procedure.

6. Historical Information and Code Maintenance

HCPCS code A9503 was added to the Healthcare Common Procedure Coding System on January 01, 1997. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has been in use for diagnostic bone scans using Technetium tc-99m medronate since its inception.

7. Medicare and Insurance Coverage

The coverage of HCPCS code A9503 may vary depending on the payer or insurance company. Medicare and other insurers may have specific pricing indicators and multiple pricing indicators for this code. It is important to verify the coverage and reimbursement policies with the respective payer to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code A9503 should be billed:

1. A patient presents with persistent bone pain, and a bone scan is ordered to evaluate for possible metastatic disease. Technetium tc-99m medronate is administered, and the bone scan is performed using a gamma camera.
2. An individual with a history of bone infection undergoes a follow-up bone scan to assess the effectiveness of the treatment. Technetium tc-99m medronate is administered, and the bone scan is performed to evaluate the response to therapy.
3. A patient with a suspected stress fracture in the foot undergoes a bone scan for further evaluation. Technetium tc-99m medronate is administered, and the bone scan is performed to identify any areas of increased uptake indicative of a stress fracture.
4. A person with a known history of bone metastases from breast cancer undergoes a bone scan to monitor disease progression. Technetium tc-99m medronate is administered, and the bone scan is performed to assess the extent of metastatic involvement in the skeletal system.
5. A patient with unexplained bone pain and elevated serum calcium levels undergoes a bone scan to evaluate for possible hyperparathyroidism. Technetium tc-99m medronate is administered, and the bone scan is performed to identify any abnormal areas of increased uptake.