How To Use HCPCS Code A9572

HCPCS code A9572 describes the use of Indium in-111 pentetreotide for diagnostic purposes. This code is used to identify the administration of the radiopharmaceutical, per study dose, up to 6 millicuries. In this article, we will explore the details of HCPCS code A9572, 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 A9572?

HCPCS code A9572 is used to identify the administration of Indium in-111 pentetreotide for diagnostic purposes. This radiopharmaceutical is used in nuclear medicine imaging studies to visualize and evaluate certain types of tumors, such as neuroendocrine tumors. It is important to note that this code is specific to the study dose of up to 6 millicuries of Indium in-111 pentetreotide.

2. Official Description

The official description of HCPCS code A9572 is “Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries.” The short description for this code is “Indium in-111 pentetreotide.”

3. Procedure

1. The procedure for HCPCS code A9572 involves the administration of Indium in-111 pentetreotide to the patient.
2. The radiopharmaceutical is typically injected into the patient’s vein.
3. After the administration, the patient may need to wait for a certain period of time to allow the radiopharmaceutical to distribute throughout the body.
4. Once the distribution is complete, the patient will undergo imaging studies, such as single-photon emission computed tomography (SPECT) or planar imaging, to visualize the uptake of Indium in-111 pentetreotide in the target tissues.
5. The images obtained from these studies are then used by the healthcare provider to diagnose and evaluate the presence and extent of certain tumors.

4. When to use HCPCS code A9572

HCPCS code A9572 should be used when the healthcare provider administers Indium in-111 pentetreotide for diagnostic purposes. This code is specifically for the study dose of up to 6 millicuries. It is important to ensure that the patient meets the appropriate clinical criteria for the use of this radiopharmaceutical and that the study is medically necessary for the evaluation of the specific condition or tumor.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9572, healthcare providers need to ensure that the following documentation requirements are met:

• Documentation of the administration of Indium in-111 pentetreotide, including the dose administered and the route of administration.
• Documentation of the medical necessity for the study, including the clinical indication and the specific condition or tumor being evaluated.
• Documentation of the imaging studies performed after the administration of the radiopharmaceutical, including the type of imaging modality used and the findings.

It is important to follow the specific billing guidelines of the payer, such as Medicare or other insurance companies, to ensure accurate and appropriate reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code A9572 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. This code has a pricing indicator code of 57, which indicates that it is priced by other carriers. 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 A9572 may be payable by Medicare and other insurance companies. The pricing indicator code of 57 indicates that the service or supply is priced by other carriers. It is important to check with the specific payer for their coverage policies and reimbursement rates for this code.

8. Examples

Here are five examples of when HCPCS code A9572 should be billed:

1. A patient with a suspected neuroendocrine tumor undergoes an Indium in-111 pentetreotide scan for diagnostic evaluation.
2. A patient with a known neuroendocrine tumor undergoes a follow-up Indium in-111 pentetreotide scan to assess the response to treatment.
3. A patient with a history of neuroendocrine tumor undergoes an Indium in-111 pentetreotide scan to evaluate the presence of metastases.
4. A patient with a suspected carcinoid tumor undergoes an Indium in-111 pentetreotide scan to confirm the diagnosis.
5. A patient with a known neuroendocrine tumor undergoes an Indium in-111 pentetreotide scan to determine the extent of the disease.