How To Use HCPCS Code A9580

HCPCS code A9580 describes the use of sodium fluoride f-18 for diagnostic purposes, specifically for a study dose of up to 30 millicuries. This code is used to identify and bill for the administration of sodium fluoride f-18 during diagnostic radiology procedures. In this article, we will explore the details of HCPCS code A9580, 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 A9580?

HCPCS code A9580 is used to identify the administration of sodium fluoride f-18 for diagnostic purposes. Sodium fluoride f-18 is a radioactive tracer commonly used in positron emission tomography (PET) scans to detect and evaluate various conditions, such as bone metastases and certain types of cancer. The code specifically refers to the study dose of sodium fluoride f-18, which can be administered up to a maximum of 30 millicuries.

2. Official Description

The official description of HCPCS code A9580 is “Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries.” This description accurately reflects the purpose and dosage limitations of this code. The short description for this code is “Sodium fluoride f-18.”

3. Procedure

1. The procedure for HCPCS code A9580 involves the administration of sodium fluoride f-18 to the patient. This is typically done through intravenous injection.
2. Prior to the administration of sodium fluoride f-18, the healthcare provider must ensure that the patient is properly prepared for the procedure. This may involve fasting for a certain period of time or avoiding certain medications.
3. The healthcare provider will calculate the appropriate dosage of sodium fluoride f-18 based on the specific study requirements and the patient’s weight.
4. The sodium fluoride f-18 is then prepared and administered to the patient via intravenous injection.
5. After the administration, the patient may be required to wait for a certain period of time to allow the tracer to distribute throughout the body.
6. The patient will then undergo the necessary imaging or scanning procedures, such as PET scans, to capture the desired diagnostic information.

4. When to use HCPCS code A9580

HCPCS code A9580 should be used when sodium fluoride f-18 is administered for diagnostic purposes. This code is specifically for the study dose of up to 30 millicuries. It is important to ensure that the administration of sodium fluoride f-18 is medically necessary and meets the criteria for diagnostic use.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9580, healthcare providers must ensure that the necessary documentation is in place to support the medical necessity of the procedure. This may include physician orders, medical records, and any relevant diagnostic reports. It is important to accurately document the dosage of sodium fluoride f-18 administered and the specific study for which it was used.

6. Historical Information and Code Maintenance

HCPCS code A9580 was added to the Healthcare Common Procedure Coding System on January 01, 2009. 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 suggests that the code has remained unchanged since its inclusion in the coding system.

7. Medicare and Insurance Coverage

The pricing indicator code for HCPCS code A9580 is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means that it is not applicable as HCPCS priced under one methodology. Medicare and other insurance providers may cover the administration of sodium fluoride f-18 for diagnostic purposes, but coverage policies may vary. It is important to check with the specific insurance carrier for their coverage guidelines and requirements.

8. Examples

Here are five examples of when HCPCS code A9580 should be billed:

1. A patient undergoes a PET scan to evaluate the presence of bone metastases. Sodium fluoride f-18 is administered as part of the study dose, up to 30 millicuries. HCPCS code A9580 should be billed for this procedure.
2. A patient with a history of certain types of cancer undergoes a follow-up PET scan to monitor the effectiveness of treatment. Sodium fluoride f-18 is administered for diagnostic purposes. HCPCS code A9580 should be billed for this procedure.
3. A patient presents with unexplained bone pain, and a PET scan is ordered to investigate potential causes. Sodium fluoride f-18 is administered as part of the diagnostic procedure. HCPCS code A9580 should be billed for this procedure.
4. A patient with a suspected bone infection undergoes a PET scan to aid in the diagnosis. Sodium fluoride f-18 is administered for diagnostic purposes. HCPCS code A9580 should be billed for this procedure.
5. A patient with a known bone tumor undergoes a PET scan to assess the extent of the tumor and plan for treatment. Sodium fluoride f-18 is administered as part of the diagnostic procedure. HCPCS code A9580 should be billed for this procedure.