How To Use HCPCS Code A9604

HCPCS code A9604 describes the therapeutic use of Samarium sm-153 lexidronam, administered as a treatment dose of up to 150 millicuries. This code is used to identify and bill for the specific procedure involving the use of this radioactive substance in therapeutic radiology. In this article, we will explore the details of HCPCS code A9604, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, as well as provide examples of when this code should be billed.

1. What is HCPCS A9604?

HCPCS code A9604 is used to identify the therapeutic use of Samarium sm-153 lexidronam. This code specifically refers to the administration of a treatment dose of up to 150 millicuries of this radioactive substance. It is important to note that this code is specific to the therapeutic radiology field and should only be used for procedures involving Samarium sm-153 lexidronam.

2. Official Description

The official description of HCPCS code A9604 is “Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries.” This description accurately reflects the purpose and usage of this code. The short description for this code is “Sm 153 lexidronam.”

3. Procedure

1. The procedure involving HCPCS code A9604 begins with the preparation of the Samarium sm-153 lexidronam solution, ensuring the correct dosage of up to 150 millicuries.
2. The healthcare provider then administers the solution to the patient through the appropriate route, which may include intravenous injection or infusion.
3. During the administration, the provider closely monitors the patient for any adverse reactions or side effects.
4. After the procedure, the provider documents the details of the treatment, including the dosage administered and any relevant patient information.

4. When to use HCPCS code A9604

HCPCS code A9604 should be used when the healthcare provider performs a therapeutic procedure involving the administration of Samarium sm-153 lexidronam. This code is specifically applicable for treatment doses of up to 150 millicuries. It is important to ensure that the procedure aligns with the official description and guidelines provided for this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9604, healthcare providers need to ensure proper documentation of the procedure. This includes documenting the dosage administered, the route of administration, and any relevant patient information. It is crucial to follow the specific billing guidelines provided by the payer to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code A9604 was added to the Healthcare Common Procedure Coding System on January 01, 2010. 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 remained unchanged since its inception.

7. Medicare and Insurance Coverage

The coverage of HCPCS code A9604 may vary depending on the payer. Medicare and other insurance providers may have specific guidelines and policies regarding the reimbursement of this procedure. It is important to check with the respective payer to determine the coverage and pricing for this code. The pricing indicator code for HCPCS code A9604 is 57, which indicates other carrier pricing. 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 scenarios where HCPCS code A9604 should be billed:

1. A patient with metastatic bone cancer receives a therapeutic dose of Samarium sm-153 lexidronam to alleviate pain and improve bone health.
2. A healthcare provider administers Samarium sm-153 lexidronam to a patient with refractory prostate cancer as part of their treatment plan.
3. A patient with multiple myeloma undergoes a Samarium sm-153 lexidronam therapy session to target and destroy cancerous cells in their bones.
4. A healthcare provider uses Samarium sm-153 lexidronam to treat a patient with painful bone metastases resulting from breast cancer.
5. A patient with osteosarcoma receives Samarium sm-153 lexidronam therapy to reduce tumor size and alleviate pain.