How To Use HCPCS Code A9552

HCPCS code A9552 describes the diagnostic use of Fluorodeoxyglucose F-18 (FDG) per study dose, up to 45 millicuries. This code is used to identify the administration of FDG for diagnostic purposes in radiology. In this article, we will explore the details of HCPCS code A9552, 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 A9552?

HCPCS code A9552 is used to identify the diagnostic use of Fluorodeoxyglucose F-18 (FDG) per study dose, up to 45 millicuries. This code specifically refers to the administration of FDG for diagnostic purposes in radiology. It is important to note that this code is not applicable for therapeutic use or any other purposes outside of diagnostic imaging.

2. Official Description

The official description of HCPCS code A9552 is “Fluorodeoxyglucose F-18 (FDG), diagnostic, per study dose, up to 45 millicuries.” The short description for this code is “F18 FDG.”

3. Procedure

1. The procedure for HCPCS code A9552 involves the administration of Fluorodeoxyglucose F-18 (FDG) for diagnostic imaging purposes.
2. The provider will prepare the FDG solution according to the manufacturer’s instructions.
3. The FDG solution is then administered to the patient via injection.
4. After the administration, the patient may be required to wait for a certain period to allow the FDG to distribute throughout the body.
5. The patient will then undergo the appropriate imaging procedure, such as positron emission tomography (PET) scan or PET/CT scan, to visualize the FDG uptake in different tissues or organs.
6. The imaging results will be interpreted by a radiologist or other qualified healthcare professional to aid in the diagnosis and management of the patient’s condition.

4. When to use HCPCS code A9552

HCPCS code A9552 should be used when administering Fluorodeoxyglucose F-18 (FDG) for diagnostic imaging purposes. This code is specifically for the per study dose of up to 45 millicuries. It is important to ensure that the use of FDG is medically necessary and meets the criteria for diagnostic imaging as determined by the healthcare provider.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9552, healthcare providers need to ensure proper documentation of the administration of FDG for diagnostic imaging. This includes documenting the dosage administered, the imaging procedure performed, and the medical necessity for the use of FDG. It is also important to follow the specific billing guidelines set forth by the payer, including any modifiers or additional documentation requirements.

6. Historical Information and Code Maintenance

HCPCS code A9552 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 falls under the pricing indicator code 53, which signifies that it is priced based on a statutory methodology. The multiple pricing indicator code A indicates that this code is not applicable as HCPCS priced under one methodology.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code A9552 may vary. It is important to check with the specific payer to determine if this code is payable and the reimbursement rates. The pricing indicator code 53 indicates that this code is priced based on a statutory methodology, which may affect the reimbursement rates. Providers should also verify any additional coverage criteria or guidelines set forth by the payer.

8. Examples

Here are five examples of when HCPCS code A9552 should be billed:

1. A patient undergoes a PET scan with FDG to evaluate the extent of cancer metastasis.
2. A patient with suspected Alzheimer’s disease undergoes a PET/CT scan with FDG to assess brain glucose metabolism.
3. A patient with a known cardiac condition undergoes a PET scan with FDG to assess myocardial viability.
4. A patient with suspected infection undergoes a PET/CT scan with FDG to identify the source and extent of the infection.
5. A patient with a suspected tumor undergoes a PET scan with FDG to determine the location and metabolic activity of the tumor.