How To Use HCPCS Code A9597

HCPCS code A9597 describes a positron emission tomography (PET) radiopharmaceutical used for diagnostic purposes in tumor identification. This code is not otherwise classified, meaning it is used when there is no specific code available to accurately describe the radiopharmaceutical being used.

1. What is HCPCS A9597?

HCPCS code A9597 is used to identify a specific PET radiopharmaceutical that is utilized for diagnostic purposes in tumor identification. This code is used when there is no other specific code available to accurately describe the radiopharmaceutical being used. It is important to note that this code is not applicable for emergency situations where immediate medical attention is required. Instead, it is used for patients who require assistance in reaching their healthcare appointments or facilities but do not have an urgent medical condition.

2. Official Description

The official description of HCPCS code A9597 is “Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified.” The short description for this code is “PET, dx, for tumor id, noc.”

3. Procedure

1. Before administering the PET radiopharmaceutical, the healthcare provider must ensure that the patient is properly prepared for the procedure. This may include fasting for a certain period of time or avoiding certain medications.
2. The radiopharmaceutical is then injected into the patient’s body, typically through a vein.
3. The patient is then positioned on a PET scanner, which detects the radiation emitted by the radiopharmaceutical.
4. The scanner captures images of the patient’s body, allowing the healthcare provider to identify and evaluate any tumors present.
5. Once the procedure is complete, the radiopharmaceutical is eliminated from the patient’s body through natural processes.

4. When to use HCPCS code A9597

HCPCS code A9597 should be used when a PET radiopharmaceutical is being used for diagnostic purposes in tumor identification, and there is no other specific code available to accurately describe the radiopharmaceutical being used. It is important to review the specific documentation and guidelines provided by the payer to ensure proper usage of this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9597, healthcare providers should ensure that the necessary documentation is in place to support the use of this code. This may include documentation of the patient’s medical history, the reason for the PET scan, and the results of the scan. Additionally, providers should follow the billing guidelines set forth by the payer to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code A9597 was added to the Healthcare Common Procedure Coding System on January 01, 2017. 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 on any changes or revisions to this code that may occur in the future.

7. Medicare and Insurance Coverage

The coverage of HCPCS code A9597 may vary depending on the payer. It is important to review the specific coverage policies of Medicare and other insurance providers to determine if this code is payable. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code A9597 should be billed:

1. A patient undergoes a PET scan using a radiopharmaceutical for the identification of a suspected tumor in the lung.
2. A patient with a history of breast cancer undergoes a PET scan to evaluate the presence of any recurrent tumors.
3. A patient with a known brain tumor undergoes a PET scan to assess the response to treatment.
4. A patient with a suspected liver tumor undergoes a PET scan to determine the extent of the tumor.
5. A patient with a suspected bone tumor undergoes a PET scan to aid in the diagnosis and staging of the tumor.