How To Use HCPCS Code A9554

HCPCS code A9554 describes the use of iodine i-125 sodium iothalamate for diagnostic purposes. This code is used to identify the administration of this radiopharmaceutical agent in a study dose, up to 10 microcuries. In this article, we will explore the official description, procedure, when to use this code, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS A9554?

HCPCS code A9554 is used to identify the administration of iodine i-125 sodium iothalamate for diagnostic purposes. This radiopharmaceutical agent is used in nuclear medicine imaging studies to evaluate the function and structure of the kidneys. It is administered in a study dose, up to 10 microcuries, to allow for accurate imaging and diagnosis.

2. Official Description

The official description of HCPCS code A9554 is “Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries.” The short description for this code is “I125 iothalamate, dx.”

3. Procedure

1. The procedure for HCPCS code A9554 involves the administration of iodine i-125 sodium iothalamate to the patient.
2. The radiopharmaceutical agent is typically injected intravenously.
3. The dosage administered should not exceed 10 microcuries.
4. After the administration, the patient may undergo imaging studies such as renal scintigraphy to evaluate kidney function and structure.
5. The results of the imaging studies can aid in the diagnosis and management of various renal conditions.

4. When to use HCPCS code A9554

HCPCS code A9554 should be used when iodine i-125 sodium iothalamate is administered for diagnostic purposes in nuclear medicine imaging studies. It is specifically used for evaluating kidney function and structure. This code should be used when the study dose does not exceed 10 microcuries.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9554, healthcare providers need to document the administration of iodine i-125 sodium iothalamate for diagnostic purposes. The documentation should include the dosage administered, the imaging studies performed, and the medical necessity for the procedure. It is important to follow the specific billing guidelines and requirements of the payer, including any necessary modifiers or additional documentation.

6. Historical Information and Code Maintenance

HCPCS code A9554 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 a pricing indicator code of 53, which indicates that it is priced based on a statutory methodology. The multiple pricing indicator code for this code is A, which means it is not applicable as HCPCS priced under one methodology.

7. Medicare and Insurance Coverage

HCPCS code A9554 may be payable by Medicare and other insurance providers. The pricing of this service or supply is determined based on the statutory methodology. It is important to verify coverage and reimbursement policies with the specific payer to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code A9554 should be billed:

1. A patient undergoes a renal scintigraphy study using iodine i-125 sodium iothalamate for the evaluation of kidney function.
2. A physician orders a diagnostic imaging study to assess the structure of the kidneys, and iodine i-125 sodium iothalamate is administered to the patient.
3. A patient with a history of renal disease undergoes a nuclear medicine imaging study using iodine i-125 sodium iothalamate to monitor kidney function.
4. A healthcare provider performs a renal scintigraphy study to evaluate the effectiveness of a treatment for a renal condition, and iodine i-125 sodium iothalamate is used as the radiopharmaceutical agent.
5. A patient presents with symptoms suggestive of kidney dysfunction, and a diagnostic imaging study using iodine i-125 sodium iothalamate is ordered to aid in the diagnosis.