How To Use HCPCS Code A9568

HCPCS code A9568 describes the diagnostic use of Technetium tc-99m arcitumomab, per study dose, up to 45 millicuries. This code is used to identify the specific procedure and service provided by healthcare providers. In this article, we will explore the details of HCPCS code A9568, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and examples of when this code should be billed.

1. What is HCPCS A9568?

HCPCS code A9568 is used to identify the diagnostic use of Technetium tc-99m arcitumomab. It represents a specific procedure or service provided by healthcare providers. This code is essential for accurate medical coding and billing, as it ensures proper documentation and reimbursement for the services rendered.

2. Official Description

The official description of HCPCS code A9568 is “Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries.” The short description for this code is “Technetium tc99m arcitumomab.”

3. Procedure

1. The procedure for HCPCS code A9568 involves the diagnostic use of Technetium tc-99m arcitumomab. This radiopharmaceutical agent is administered to the patient for diagnostic imaging purposes.
2. The healthcare provider prepares the dose of Technetium tc-99m arcitumomab according to the specific study requirements.
3. The prepared dose is then administered to the patient through intravenous injection.
4. After the administration, the patient undergoes imaging procedures, such as single-photon emission computed tomography (SPECT) or planar imaging, to obtain diagnostic information.
5. The results of the imaging procedures are used for diagnostic purposes, aiding in the detection and evaluation of certain medical conditions.

4. When to use HCPCS code A9568

HCPCS code A9568 should be used when healthcare providers perform the diagnostic procedure using Technetium tc-99m arcitumomab. This code is applicable when the provider administers the radiopharmaceutical agent and performs the necessary imaging procedures for diagnostic purposes. It is important to ensure that the specific study dose does not exceed 45 millicuries, as stated in the official description of the code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9568, healthcare providers need to document the following information:

• Date of service
• Administration of Technetium tc-99m arcitumomab
• Imaging procedures performed
• Results of the imaging procedures

Proper documentation is crucial for accurate coding and billing. It ensures that the services provided are appropriately reimbursed by insurance companies or Medicare.

6. Historical Information and Code Maintenance

HCPCS code A9568 was added to the Healthcare Common Procedure Coding System on January 01, 2007. 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 signifies that it is priced based on a statutory methodology. The multiple pricing indicator code for this code is A, indicating that it is not applicable as HCPCS priced under one methodology.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code A9568 may vary. It is essential to check with the specific insurance provider or Medicare to determine the coverage and reimbursement policies for this code. The pricing indicator code and multiple pricing indicator code provide information on how the service or supply is priced by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code A9568 should be billed:

1. A patient undergoes a diagnostic imaging study using Technetium tc-99m arcitumomab to evaluate the presence of cancerous cells.
2. A healthcare provider administers Technetium tc-99m arcitumomab to a patient and performs imaging procedures to assess the extent of an infection.
3. A diagnostic study is conducted using Technetium tc-99m arcitumomab to evaluate the functionality of a specific organ.
4. A patient with suspected autoimmune disease undergoes a diagnostic imaging study using Technetium tc-99m arcitumomab to aid in the diagnosis.
5. A healthcare provider utilizes Technetium tc-99m arcitumomab for a diagnostic study to assess the effectiveness of a particular treatment.