How To Use HCPCS Code C8937

HCPCS code C8937 describes a computer-aided detection procedure that involves the analysis of breast MRI image data for lesion detection and characterization. This code is used when a computer algorithm is utilized to perform a pharmacokinetic analysis of the breast MRI images, followed by a physician’s review and interpretation of the results. It is important to note that this code should be listed separately in addition to the primary procedure code.

1. What is HCPCS C8937?

HCPCS code C8937 is a specific code used to identify the computer-aided detection procedure for breast MRI image data analysis. It is important to use this code accurately to ensure proper billing and reimbursement for the services provided.

2. Official Description

The official description of HCPCS code C8937 is as follows: “Computer-aided detection, including computer algorithm analysis of breast MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation (list separately in addition to code for primary procedure).” The short description for this code is “Parenteral supp not othrws c.”

3. Procedure

1. The computer-aided detection procedure begins with the acquisition of breast MRI image data.
2. A computer algorithm is then utilized to analyze the image data for lesion detection and characterization.
3. Following the computer analysis, a physician reviews the results of the algorithm and performs further interpretation.
4. The physician’s interpretation is crucial in determining the presence and characteristics of any detected lesions.
5. It is important to note that this procedure should be listed separately in addition to the primary procedure code.

4. When to use HCPCS code C8937

HCPCS code C8937 should be used when performing a computer-aided detection procedure for breast MRI image data analysis. This code is specifically applicable when a computer algorithm is used to detect and characterize lesions in the breast MRI images, followed by a physician’s review and interpretation of the results. It is important to ensure that the procedure meets the specific criteria outlined in the code description before using this code for billing purposes.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C8937, healthcare providers should ensure that the necessary documentation is in place to support the services provided. This may include the following:

• Documentation of the breast MRI image data acquisition
• Documentation of the computer algorithm analysis
• Documentation of the physician’s review and interpretation
• Any additional relevant documentation supporting the need for the computer-aided detection procedure

6. Historical Information and Code Maintenance

HCPCS code C8937 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. As indicated by the action code N, no maintenance actions have been taken for this code. This means that there have been no updates or revisions to the code since its addition.

7. Medicare and Insurance Coverage

HCPCS code C8937 is subject to specific coverage instructions, as indicated by the coverage code D. This means that special coverage instructions apply when billing for this code. 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.

8. Examples

Here are five examples of scenarios in which HCPCS code C8937 should be billed:

1. A patient undergoes a breast MRI, and the computer-aided detection procedure is performed to analyze the image data for lesion detection and characterization. The physician reviews and interprets the results.
2. A patient with a history of breast cancer undergoes a follow-up breast MRI. The computer algorithm is utilized to analyze the image data, and the physician reviews the results to assess any changes or new lesions.
3. A patient presents with suspicious findings on a mammogram. A breast MRI is ordered, and the computer-aided detection procedure is performed to aid in the detection and characterization of any lesions.
4. A patient with a known breast abnormality undergoes a breast MRI. The computer algorithm is used to analyze the image data, and the physician reviews the results to determine the nature of the abnormality.
5. A patient with a family history of breast cancer undergoes a screening breast MRI. The computer-aided detection procedure is performed to assist in the identification of any potential lesions, and the physician reviews the results for interpretation.