How To Use HCPCS Code C8903

HCPCS code C8903 describes a specific procedure known as magnetic resonance imaging (MRI) with contrast for the breast, performed unilaterally. This code is used to identify and bill for this particular imaging service, which involves the use of contrast agents to enhance the visibility of breast tissue during the MRI scan.

1. What is HCPCS C8903?

HCPCS code C8903 is a specific code used in medical coding to identify and bill for the procedure of magnetic resonance imaging (MRI) with contrast for the breast, performed on one side only. This code is essential for accurate and efficient billing and reimbursement processes.

2. Official Description

The official description of HCPCS code C8903 is “Magnetic resonance imaging with contrast, breast; unilateral.” This description clearly indicates that the procedure involves the use of contrast agents during the MRI scan to enhance the visualization of breast tissue. The short description for this code is “Enteral supp not otherwise c,” which may seem unrelated but is a result of the coding system’s structure.

3. Procedure

1. The patient is positioned on the MRI table, usually lying face down.
2. A contrast agent, typically a gadolinium-based solution, is administered intravenously to the patient.
3. The MRI machine generates a strong magnetic field and radio waves to create detailed images of the breast tissue.
4. The contrast agent helps highlight any abnormalities or areas of concern within the breast.
5. The radiologist or technician captures the necessary images and ensures the quality and clarity of the scans.
6. Once the procedure is complete, the patient can leave the imaging facility.

4. When to use HCPCS code C8903

HCPCS code C8903 should be used when a healthcare provider performs a magnetic resonance imaging (MRI) scan with contrast for the breast on one side only. This code is specific to unilateral breast MRI scans and should not be used for bilateral procedures or other types of imaging studies.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C8903, healthcare providers need to ensure accurate documentation of the procedure, including the use of contrast agents and the unilateral nature of the scan. It is crucial to include the patient’s medical records, the reason for the MRI, and any relevant findings or observations during the procedure. Proper documentation helps support the medical necessity of the service and facilitates appropriate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C8903 was added to the Healthcare Common Procedure Coding System on January 01, 1985. 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 and continues to be used for unilateral breast MRI scans with contrast.

7. Medicare and Insurance Coverage

HCPCS code C8903 is eligible for coverage by Medicare and other insurance providers. The pricing indicator code 57 indicates that the service is priced by other carriers, meaning that the reimbursement rates may vary depending on the specific insurance plan or contract. The multiple pricing indicator code A signifies that the code is not applicable for pricing under a single methodology.

8. Examples

Here are five examples of scenarios where HCPCS code C8903 would be appropriate for billing:

1. A 45-year-old female presents with a suspicious lump in her left breast. The physician orders a unilateral breast MRI with contrast to further evaluate the abnormality.
2. A patient with a history of breast cancer undergoes routine surveillance imaging. The radiologist performs a unilateral breast MRI with contrast to monitor for any signs of recurrence or metastasis.
3. A woman with a strong family history of breast cancer undergoes a unilateral breast MRI with contrast as part of a high-risk screening program.
4. A patient with a known breast abnormality detected on mammography undergoes a unilateral breast MRI with contrast to obtain more detailed information and aid in treatment planning.
5. A postoperative breast reconstruction patient undergoes a unilateral breast MRI with contrast to assess the integrity of the reconstructed breast and detect any complications.