How To Use HCPCS Code A9569

HCPCS code A9569 describes the use of Technetium tc-99m exametazime labeled autologous white blood cells for diagnostic purposes. This code is used to identify the administration of this radiopharmaceutical agent to aid in the diagnosis of certain medical conditions. In this article, we will explore the details of HCPCS code A9569, 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 A9569?

HCPCS code A9569 is used to identify the administration of Technetium tc-99m exametazime labeled autologous white blood cells for diagnostic purposes. This code specifically refers to the study dose of this radiopharmaceutical agent. It is important to note that this code is used for diagnostic purposes only and should not be used for therapeutic or treatment-related procedures.

2. Official Description

The official description of HCPCS code A9569 is “Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose.” This description accurately reflects the purpose and usage of this code. The short description of this code is “Technetium tc-99m auto wbc.”

3. Procedure

1. The procedure for HCPCS code A9569 involves the administration of Technetium tc-99m exametazime labeled autologous white blood cells to the patient. This radiopharmaceutical agent is typically injected intravenously.
2. Prior to the administration of the radiopharmaceutical agent, the patient’s white blood cells are collected through a process known as leukapheresis.
3. The collected white blood cells are then labeled with Technetium tc-99m exametazime, which allows for their visualization during diagnostic imaging procedures.
4. Once the white blood cells are labeled, they are reinfused back into the patient’s bloodstream.
5. Following the administration of the radiopharmaceutical agent, the patient undergoes diagnostic imaging, such as single-photon emission computed tomography (SPECT) or planar imaging, to assess the distribution and function of the labeled white blood cells.

4. When to use HCPCS code A9569

HCPCS code A9569 should be used when the provider administers Technetium tc-99m exametazime labeled autologous white blood cells for diagnostic purposes. This code is typically used in the evaluation of suspected infections, such as osteomyelitis or abscesses, as well as in the assessment of inflammatory conditions.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9569, healthcare providers should ensure that the following documentation is included:

• Medical necessity for the administration of Technetium tc-99m exametazime labeled autologous white blood cells
• Documentation supporting the specific diagnostic purpose for which the procedure is being performed
• Details of the leukapheresis procedure, including the collection and labeling of the patient’s white blood cells
• Documentation of the diagnostic imaging procedure performed following the administration of the radiopharmaceutical agent

Providers should also follow the appropriate coding and billing guidelines set forth by Medicare or other insurance carriers when submitting claims for reimbursement.

6. Historical Information and Code Maintenance

HCPCS code A9569 was added to the Healthcare Common Procedure Coding System on January 01, 2008. 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.

7. Medicare and Insurance Coverage

Medicare and other insurance carriers may provide coverage for HCPCS code A9569, subject to their specific guidelines and policies. The pricing indicator code for this code is 57, which indicates that it is priced by carriers using other methodologies. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of scenarios in which HCPCS code A9569 should be billed:

1. A patient presents with suspected osteomyelitis, and the provider administers Technetium tc-99m exametazime labeled autologous white blood cells for diagnostic imaging to assess the presence and extent of the infection.
2. A patient with a history of inflammatory bowel disease experiences a flare-up, and the provider orders Technetium tc-99m exametazime labeled autologous white blood cell imaging to evaluate the extent and severity of the inflammation.
3. A patient with a suspected abscess undergoes Technetium tc-99m exametazime labeled autologous white blood cell imaging to determine the location and size of the abscess for appropriate treatment planning.
4. A patient with suspected infection in a joint receives Technetium tc-99m exametazime labeled autologous white blood cells for diagnostic imaging to assess the presence of infection and guide further management.
5. A patient with suspected infection in a prosthetic device undergoes Technetium tc-99m exametazime labeled autologous white blood cell imaging to evaluate the presence of infection and aid in the decision-making process for device removal or retention.