How To Use HCPCS Code C2635

HCPCS code C2635 describes a specific type of brachytherapy source used in medical procedures. This code is used to identify a non-stranded, high activity palladium-103 source with an activity level greater than 2.2 mCi (nist). It is important for medical coders to understand the meaning and usage of this code in order to accurately document and bill for the services provided.

1. What is HCPCS C2635?

HCPCS code C2635 is used to identify a brachytherapy source that is non-stranded, high activity, and contains palladium-103. Brachytherapy is a type of radiation therapy where a radioactive source is placed directly into or near the tumor site. This specific code represents a palladium-103 source with an activity level greater than 2.2 mCi (nist) per source.

2. Official Description

The official description of HCPCS code C2635 is “Brachytherapy source, non-stranded, high activity, palladium-103, greater than 2.2 mci (nist), per source.” The short description for this code is “Parenteral supp not othrws c.”

3. Procedure

1. The provider begins the procedure by preparing the brachytherapy source, ensuring that it is non-stranded and contains palladium-103.
2. The provider then determines the appropriate activity level for the source, ensuring that it is greater than 2.2 mCi (nist) per source.
3. The source is then placed directly into or near the tumor site, delivering localized radiation therapy.
4. The provider carefully monitors the patient during the procedure to ensure the correct placement and dosage of radiation.
5. After the procedure, the brachytherapy source is removed from the patient.

4. When to use HCPCS code C2635

HCPCS code C2635 should be used when documenting and billing for brachytherapy procedures that utilize a non-stranded, high activity palladium-103 source with an activity level greater than 2.2 mCi (nist) per source. It is important to ensure that the specific criteria for this code are met in order to accurately report the services provided.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code C2635, healthcare providers should ensure that the documentation supports the use of a non-stranded, high activity palladium-103 source with an activity level greater than 2.2 mCi (nist) per source. This may include detailed procedure notes, imaging studies, and any other relevant documentation. It is also important to follow any specific billing guidelines provided by Medicare or other insurance carriers.

6. Historical Information and Code Maintenance

HCPCS code C2635 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996, and 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 been in use for several years and has not undergone any significant changes since its addition.

7. Medicare and Insurance Coverage

HCPCS code C2635 is eligible for coverage by Medicare and other insurance carriers. 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 that it is not applicable as HCPCS priced under one methodology. Providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for additional guidance on billing and reimbursement for services using this code.

8. Examples

Here are five examples of when HCPCS code C2635 should be billed:

1. A patient undergoes brachytherapy for the treatment of prostate cancer using a non-stranded, high activity palladium-103 source with an activity level greater than 2.2 mCi (nist) per source.
2. A patient receives brachytherapy for the treatment of cervical cancer using a non-stranded, high activity palladium-103 source with an activity level greater than 2.2 mCi (nist) per source.
3. A patient undergoes brachytherapy for the treatment of breast cancer using a non-stranded, high activity palladium-103 source with an activity level greater than 2.2 mCi (nist) per source.
4. A patient receives brachytherapy for the treatment of lung cancer using a non-stranded, high activity palladium-103 source with an activity level greater than 2.2 mCi (nist) per source.
5. A patient undergoes brachytherapy for the treatment of head and neck cancer using a non-stranded, high activity palladium-103 source with an activity level greater than 2.2 mCi (nist) per source.