How To Use HCPCS Code A9542

HCPCS code A9542 describes the diagnostic use of Indium in-111 ibritumomab tiuxetan, per study dose, up to 5 millicuries. This code is used to identify the specific procedure and is essential for accurate medical coding and billing. In this article, we will delve into the details of HCPCS code A9542, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS A9542?

HCPCS code A9542 is used to identify the diagnostic use of Indium in-111 ibritumomab tiuxetan, per study dose, up to 5 millicuries. This code is specific to the administration of this diagnostic radiopharmaceutical and is used to accurately document and bill for this procedure.

2. Official Description

The official description of HCPCS code A9542 is “Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries.” The short description for this code is “In111 ibritumomab, dx.”

3. Procedure

1. The procedure for HCPCS code A9542 involves the administration of Indium in-111 ibritumomab tiuxetan for diagnostic purposes.
2. The provider will prepare the necessary equipment and supplies for the administration of the radiopharmaceutical.
3. The patient will be positioned appropriately for the procedure.
4. The provider will administer the Indium in-111 ibritumomab tiuxetan per the study dose, up to 5 millicuries.
5. After the administration, the patient may be monitored for any adverse reactions or side effects.
6. The provider will document the procedure and any relevant findings in the patient’s medical record.

4. When to use HCPCS code A9542

HCPCS code A9542 should be used when administering Indium in-111 ibritumomab tiuxetan for diagnostic purposes. It is important to ensure that the patient meets the specific eligibility criteria or guidelines for this procedure. This code is not applicable for other uses or different radiopharmaceuticals.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9542, healthcare providers need to document the administration of Indium in-111 ibritumomab tiuxetan for diagnostic purposes. The documentation should include the dosage administered, any relevant findings, and the medical necessity for the procedure. Proper documentation is crucial for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code A9542 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 code has remained unchanged since its inclusion in the coding system.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the diagnostic use of Indium in-111 ibritumomab tiuxetan when billed with HCPCS code A9542. The pricing indicator code for this code is 51, which indicates that it falls under the category of drugs. The multiple pricing indicator code is A, which means it is not applicable as HCPCS is priced under one methodology. It is important to check with individual payers for their specific coverage policies and reimbursement rates.

8. Examples

Here are five examples of when HCPCS code A9542 should be billed:

1. A patient with suspected lymphoma undergoes a diagnostic scan using Indium in-111 ibritumomab tiuxetan to assess the extent and location of the disease.
2. A patient with a history of breast cancer undergoes a diagnostic scan using Indium in-111 ibritumomab tiuxetan to evaluate the presence of metastases.
3. A patient with suspected bone marrow involvement undergoes a diagnostic scan using Indium in-111 ibritumomab tiuxetan to determine the extent of the disease.
4. A patient with suspected infection in a prosthetic joint undergoes a diagnostic scan using Indium in-111 ibritumomab tiuxetan to identify the presence of infection.
5. A patient with suspected gastrointestinal bleeding undergoes a diagnostic scan using Indium in-111 ibritumomab tiuxetan to locate the source of bleeding.