How To Use HCPCS Code A9561

HCPCS code A9561 describes the diagnostic use of Technetium tc-99m oxidronate, per study dose, up to 30 millicuries. This code is used to identify the administration of this specific radiopharmaceutical for diagnostic purposes. 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 A9561?

HCPCS code A9561 is used to identify the diagnostic use of Technetium tc-99m oxidronate. This radiopharmaceutical is administered as a study dose, with a maximum activity of 30 millicuries. It is commonly used in nuclear medicine imaging procedures to evaluate bone metabolism and detect abnormalities such as bone tumors, infections, and fractures.

2. Official Description

The official description of HCPCS code A9561 is “Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries.” The short description for this code is “Tc99m oxidronate.”

3. Procedure

1. The procedure for administering Technetium tc-99m oxidronate involves several steps:
2. Prepare the radiopharmaceutical by reconstituting the kit with the appropriate volume of sterile, pyrogen-free sodium pertechnetate Tc-99m injection.
3. Perform quality control tests to ensure the radiopharmaceutical’s integrity and activity.
4. Administer the Technetium tc-99m oxidronate intravenously to the patient.
5. Allow sufficient time for the radiopharmaceutical to distribute and accumulate in the bones.
6. Perform the nuclear medicine imaging procedure, such as a bone scan or SPECT/CT, to visualize the skeletal system.
7. Interpret the imaging results and document the findings in the patient’s medical record.

4. When to use HCPCS code A9561

HCPCS code A9561 should be used when administering Technetium tc-99m oxidronate for diagnostic purposes. This code is typically used in nuclear medicine imaging procedures to evaluate bone metabolism and detect bone-related abnormalities. It is important to ensure that the patient meets the specific indications for this procedure, as determined by the ordering physician.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9561, healthcare providers should ensure that the following documentation is included:

• Order from the referring physician for the diagnostic procedure
• Documentation of the patient’s medical necessity for the procedure
• Documentation of the radiopharmaceutical administered, including the dose and activity
• Documentation of the nuclear medicine imaging procedure performed
• Interpretation and findings of the imaging results

Providers should follow the appropriate coding and billing guidelines of their respective payers to ensure accurate and timely reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code A9561 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 inception.

7. Medicare and Insurance Coverage

Medicare and other insurance carriers may provide coverage for HCPCS code A9561, subject to their specific policies and guidelines. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. Providers should verify coverage and reimbursement policies with the respective payers to ensure proper billing and reimbursement.

8. Examples

Here are five examples of scenarios in which HCPCS code A9561 should be billed:

1. A patient presents with persistent bone pain, and a bone scan is ordered to evaluate for possible metastatic disease.
2. A patient with a history of osteomyelitis undergoes a follow-up bone scan to assess treatment response.
3. A patient with suspected stress fractures undergoes a bone scan to confirm the diagnosis.
4. A patient with a known bone tumor undergoes a bone scan to assess tumor activity and response to treatment.
5. A patient with suspected osteoporosis undergoes a bone scan to evaluate bone density and assess fracture risk.