How To Use HCPCS Code A9585

HCPCS code A9585 describes the injection of gadobutrol, a contrast agent used in diagnostic radiology procedures. This code is used to identify the specific service provided and to facilitate accurate billing and reimbursement for healthcare providers.

1. What is HCPCS A9585?

HCPCS code A9585 is a specific code used to identify the injection of gadobutrol, which is a contrast agent commonly used in diagnostic radiology procedures. This code is essential for accurate documentation and billing purposes, ensuring that healthcare providers are appropriately reimbursed for the services they provide.

2. Official Description

The official description of HCPCS code A9585 is “Injection, gadobutrol, 0.1 ml.” This description clearly indicates the specific service being provided, which is the injection of gadobutrol in a volume of 0.1 ml. The short description for this code is “Gadobutrol injection,” providing a concise summary of the service.

3. Procedure

1. The healthcare provider prepares the necessary equipment and ensures the proper dosage of gadobutrol.
2. The patient is positioned appropriately for the radiology procedure.
3. The healthcare provider administers the gadobutrol injection, following established protocols and guidelines.
4. After the injection, the patient may be monitored for any immediate adverse reactions or side effects.
5. The radiology procedure is then performed, utilizing the contrast agent to enhance the visibility of specific structures or abnormalities.

4. When to use HCPCS code A9585

HCPCS code A9585 should be used when healthcare providers administer gadobutrol injections as part of a diagnostic radiology procedure. This code is specific to the injection of gadobutrol and should not be used for other contrast agents or unrelated services. It is important to ensure accurate coding to facilitate proper billing and reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9585, healthcare providers should ensure that the following documentation requirements are met:

• Accurate identification of the patient receiving the injection
• Date and time of the injection
• Volume of gadobutrol administered (0.1 ml)
• Documentation of any immediate adverse reactions or side effects
• Documentation of the radiology procedure performed utilizing the contrast agent

These documentation requirements are essential for proper billing and reimbursement, as they provide evidence of the services rendered and the medical necessity of the gadobutrol injection.

6. Historical Information and Code Maintenance

HCPCS code A9585 was added to the Healthcare Common Procedure Coding System on January 01, 2012. 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

Medicare and other insurance providers may cover the gadobutrol injection when it is medically necessary for a diagnostic radiology procedure. The pricing indicator code 57 indicates that the service is priced by other carriers, and the multiple pricing indicator code A signifies that the code is not applicable as HCPCS priced under one methodology. It is important for healthcare providers to verify coverage and reimbursement policies with the specific insurance carrier to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code A9585 should be billed:

1. A patient undergoes an MRI scan with gadobutrol injection to enhance the visibility of brain lesions.
2. A patient receives a gadobutrol injection prior to a CT angiography to visualize blood vessels in the abdomen.
3. A patient undergoes a gadobutrol-enhanced MRI of the knee to assess for ligament tears or other abnormalities.
4. A patient receives a gadobutrol injection before a liver MRI to evaluate liver lesions or tumors.
5. A patient undergoes a gadobutrol-enhanced MRI of the spine to assess for spinal cord compression or herniated discs.