How To Use HCPCS Code A9596

HCPCS code A9596 describes the diagnostic use of Gallium Ga-68 gozetotide, also known as illuccix. This code is used to identify the administration of this radiopharmaceutical for diagnostic purposes. In this article, we will explore the details of HCPCS code A9596, 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 A9596?

HCPCS code A9596 is used to identify the diagnostic use of Gallium Ga-68 gozetotide, also known as illuccix. This radiopharmaceutical is administered to patients for diagnostic imaging purposes. It is important to note that this code specifically refers to the diagnostic use of Gallium Ga-68 gozetotide and not for any other purposes.

2. Official Description

The official description of HCPCS code A9596 is “Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie.” This description accurately represents the specific radiopharmaceutical and the quantity administered for diagnostic purposes. The short description of this code is “Gallium illuccix 1 millicurie.”

3. Procedure

1. The procedure for administering Gallium Ga-68 gozetotide involves several steps:
2. Prepare the necessary equipment and supplies for the administration.
3. Verify the patient’s identity and confirm the appropriateness of the diagnostic procedure.
4. Administer the Gallium Ga-68 gozetotide intravenously, following proper aseptic techniques.
5. Monitor the patient for any adverse reactions or side effects during and after the administration.
6. Document the administration details, including the dosage, route, and any observations.

4. When to use HCPCS code A9596

HCPCS code A9596 should be used when administering Gallium Ga-68 gozetotide for diagnostic purposes. It is important to ensure that the patient meets the specific criteria for this diagnostic procedure and that it is medically necessary. The use of this code should be supported by appropriate documentation and indications for the diagnostic imaging.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9596, healthcare providers need to ensure that the necessary documentation is in place. This includes documenting the medical necessity for the diagnostic procedure, the dosage administered, and any relevant clinical information. Additionally, proper coding and billing guidelines should be followed to ensure accurate reimbursement for the service provided.

6. Historical Information and Code Maintenance

HCPCS code A9596 was added to the Healthcare Common Procedure Coding System on July 01, 2022. As of the effective date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important to stay updated with any future changes or revisions to this code.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code A9596 may vary depending on the payer, including Medicare and other insurance providers. The pricing indicator code 57 indicates that this code is priced by other carriers. The multiple pricing indicator code A signifies that it is not applicable as HCPCS priced under one methodology. Healthcare providers should verify the coverage and reimbursement policies of the specific payer before submitting claims for this code.

8. Examples

Here are five examples of scenarios where HCPCS code A9596 should be billed:

1. Example 1: A patient with suspected neuroendocrine tumors undergoes a diagnostic imaging procedure using Gallium Ga-68 gozetotide to assess the presence and extent of the tumors.
2. Example 2: A patient with a history of carcinoid syndrome undergoes a follow-up diagnostic scan using Gallium Ga-68 gozetotide to monitor the progression of the disease.
3. Example 3: A patient with a suspected gastrointestinal neuroendocrine tumor undergoes a diagnostic imaging procedure using Gallium Ga-68 gozetotide to aid in the diagnosis and staging of the tumor.
4. Example 4: A patient with a known history of neuroendocrine tumors undergoes a routine surveillance scan using Gallium Ga-68 gozetotide to monitor the response to treatment and detect any recurrence.
5. Example 5: A patient with suspected somatostatin receptor-positive tumors undergoes a diagnostic imaging procedure using Gallium Ga-68 gozetotide to identify the presence and location of the tumors.