How To Use HCPCS Code A9591

HCPCS code A9591 describes the diagnostic use of Fluoroestradiol F 18, a radiopharmaceutical used in diagnostic radiology. This code is used to identify and bill for the administration of Fluoroestradiol F 18, which is used in certain imaging procedures to detect and evaluate estrogen receptor-positive tumors in patients with breast cancer.

1. What is HCPCS A9591?

HCPCS code A9591 is a specific code used to identify the diagnostic use of Fluoroestradiol F 18. It is important for medical coders to understand the meaning and usage of this code in order to accurately bill for the administration of this radiopharmaceutical.

2. Official Description

The official description of HCPCS code A9591 is “Fluoroestradiol F 18, diagnostic, 1 millicurie.” The short description for this code is “Fluoroestradiol F 18.”

3. Procedure

1. The procedure for HCPCS code A9591 involves the administration of Fluoroestradiol F 18 to the patient.
2. The radiopharmaceutical is typically administered intravenously.
3. After administration, the patient undergoes imaging procedures, such as positron emission tomography (PET), to detect and evaluate estrogen receptor-positive tumors.
4. The imaging results are then used by healthcare providers to make diagnostic and treatment decisions for patients with breast cancer.

4. When to use HCPCS code A9591

HCPCS code A9591 should be used when administering Fluoroestradiol F 18 for diagnostic purposes in patients with breast cancer. It is specifically used to identify and bill for the use of this radiopharmaceutical in imaging procedures to detect and evaluate estrogen receptor-positive tumors.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9591, healthcare providers need to document the administration of Fluoroestradiol F 18 and the specific imaging procedures performed. They should also include the medical necessity for using this radiopharmaceutical in the patient’s medical record.

6. Historical Information and Code Maintenance

HCPCS code A9591 was added to the Healthcare Common Procedure Coding System on January 01, 2021. As of January 01, 2024, there will be a payment change for this code. The pricing indicator code for A9591 is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may provide coverage for HCPCS code A9591. The specific pricing and coverage details may vary depending on the insurer. It is important for healthcare providers to verify coverage and follow the billing guidelines set by each insurer.

8. Examples

Here are five examples of when HCPCS code A9591 should be billed:

1. A patient with a history of breast cancer undergoes a PET scan using Fluoroestradiol F 18 to evaluate the presence and extent of estrogen receptor-positive tumors.
2. A patient with a suspected recurrence of breast cancer undergoes a diagnostic imaging procedure using Fluoroestradiol F 18 to determine the location and characteristics of the tumor.
3. A patient with metastatic breast cancer undergoes regular imaging follow-up using Fluoroestradiol F 18 to monitor the response to treatment and assess disease progression.
4. A patient with a newly diagnosed breast cancer undergoes a preoperative imaging procedure using Fluoroestradiol F 18 to determine the extent of the tumor and guide surgical planning.
5. A patient with a known estrogen receptor-positive breast cancer undergoes a restaging PET scan using Fluoroestradiol F 18 to assess the response to hormone therapy and guide further treatment decisions.