How To Use HCPCS Code A9540

HCPCS code A9540 describes Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries. This code is used to identify a specific diagnostic radiology procedure involving the use of Technetium tc-99m macroaggregated albumin. In this article, we will explore the official description of HCPCS code A9540, the procedure itself, when to use this code, billing guidelines and documentation requirements, historical information and code maintenance, Medicare and insurance coverage, as well as provide examples of when this code should be billed.

1. What is HCPCS A9540?

HCPCS code A9540 is used to identify the diagnostic procedure involving the administration of Technetium tc-99m macroaggregated albumin. This procedure is used to assess lung perfusion and is typically performed in nuclear medicine departments or facilities. The code represents the per study dose of up to 10 millicuries of Technetium tc-99m macroaggregated albumin.

2. Official Description

The official description of HCPCS code A9540 is “Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries.” The short description for this code is “Tc99m maa.”

3. Procedure

1. The procedure begins with the preparation of the Technetium tc-99m macroaggregated albumin solution.
2. The solution is then administered to the patient intravenously.
3. Following the administration, the patient is positioned appropriately for imaging.
4. A gamma camera is used to capture images of the lungs, allowing for the assessment of lung perfusion.
5. The images are then interpreted by a qualified healthcare professional to make a diagnosis.

4. When to use HCPCS code A9540

HCPCS code A9540 should be used when performing a diagnostic study involving the administration of Technetium tc-99m macroaggregated albumin. This procedure is typically used to assess lung perfusion in patients with suspected pulmonary embolism or other lung-related conditions. It is important to ensure that the patient meets the necessary eligibility criteria for this procedure before using HCPCS code A9540.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9540, healthcare providers should ensure that the necessary documentation is in place to support the medical necessity of the procedure. This may include the patient’s medical history, relevant diagnostic test results, and any other supporting documentation. Additionally, providers should follow the appropriate billing guidelines set forth by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code A9540 was added to the Healthcare Common Procedure Coding System on January 01, 2006. 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 suggests that the code has remained unchanged since its inception.

7. Medicare and Insurance Coverage

HCPCS code A9540 is eligible for coverage by Medicare and other insurance carriers. The pricing indicator code 57 indicates that the service or supply is priced by other carriers. The multiple pricing indicator code A signifies that the code is not applicable as HCPCS priced under one methodology. It is important for healthcare providers to verify coverage and reimbursement policies with the respective payers to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code A9540 should be billed:

1. A patient presents with symptoms of pulmonary embolism. The physician orders a lung perfusion study using Technetium tc-99m macroaggregated albumin to assess the patient’s lung perfusion.
2. A patient with a known lung condition requires a follow-up lung perfusion study to monitor the progression of the disease.
3. A patient undergoes a pre-operative evaluation, and a lung perfusion study is ordered to assess the patient’s lung function prior to surgery.
4. A patient with a history of lung disease undergoes a routine lung perfusion study as part of their ongoing care and management.
5. A patient with suspected pulmonary hypertension undergoes a lung perfusion study to evaluate blood flow to the lungs.