How To Use HCPCS Code A9598

HCPCS code A9598 describes a positron emission tomography (PET) radiopharmaceutical used for diagnostic purposes in non-tumor identification. This code is classified as a diagnostic radiology service and is used to identify and bill for the administration of a specific radiopharmaceutical during a PET scan. In this article, we will explore the details of HCPCS code A9598, 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 A9598?

HCPCS code A9598 is used to identify a specific PET radiopharmaceutical that is utilized for non-tumor identification. This code is not otherwise classified, meaning it is used when there is no other specific code available to describe the radiopharmaceutical being administered during the PET scan. It is important to note that this code is not used for tumor identification, as there are separate codes available for that purpose.

2. Official Description

The official description of HCPCS code A9598 is “Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified.” The short description of this code is “Pet dx for non-tumor id, noc.”

3. Procedure

1. The procedure for HCPCS code A9598 involves the administration of a specific PET radiopharmaceutical to the patient.
2. The radiopharmaceutical is typically injected into the patient’s bloodstream.
3. After the administration of the radiopharmaceutical, the patient undergoes a PET scan.
4. The PET scan uses a specialized camera to detect the radioactive signals emitted by the radiopharmaceutical.
5. The signals are then processed to create detailed images of the patient’s internal organs and tissues.
6. These images are used by healthcare providers to diagnose and identify non-tumor conditions.

4. When to use HCPCS code A9598

HCPCS code A9598 should be used when a PET scan is performed for the purpose of non-tumor identification. This code is specifically for cases where there is no other specific code available to describe the radiopharmaceutical being used. It is important to review the documentation and ensure that the PET scan is being performed for non-tumor identification before using this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9598, healthcare providers need to document the administration of the specific PET radiopharmaceutical and the performance of the PET scan for non-tumor identification. The documentation should include the dosage of the radiopharmaceutical administered, the date of the procedure, and the medical necessity for performing the PET scan. It is also important to ensure that the documentation supports the use of this specific code and that there is no other appropriate code available to describe the radiopharmaceutical being used.

6. Historical Information and Code Maintenance

HCPCS code A9598 was added to the Healthcare Common Procedure Coding System on January 01, 2017. 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 code has a pricing indicator code of 57, which indicates that it is priced by other carriers. The multiple pricing indicator code for this code is A, which means 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 A9598, depending on their specific policies and guidelines. It is important to check with the individual payer to determine their coverage and reimbursement policies for this code. The pricing indicator code and multiple pricing indicator code provide information on how the service or supply is priced by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code A9598 should be billed:

1. A patient undergoes a PET scan with the administration of a specific radiopharmaceutical for the identification of non-tumor conditions.
2. A physician orders a PET scan with a non-tumor identification radiopharmaceutical to evaluate a patient’s cardiac function.
3. A healthcare provider performs a PET scan with a non-tumor identification radiopharmaceutical to assess the extent of inflammation in a patient’s joints.
4. A PET scan is conducted with the administration of a specific radiopharmaceutical to identify non-tumor abnormalities in a patient’s brain.
5. A healthcare facility performs a PET scan with a non-tumor identification radiopharmaceutical to evaluate the metabolic activity of a patient’s liver.