How To Use HCPCS Code C9053

HCPCS code C9053 describes the injection of crizanlizumab-tmca, with a dosage of 1 mg. This code is used to identify and bill for this specific medication administration procedure. In this article, we will explore the details of HCPCS code C9053, 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 C9053?

HCPCS code C9053 is a specific code used to identify the injection of crizanlizumab-tmca, with a dosage of 1 mg. It is important for medical coders to accurately assign this code when billing for this particular medication administration procedure.

2. Official Description

The official description for HCPCS code C9053 is “Injection, crizanlizumab-tmca, 1 mg”. The short description for this code is “Enteral supp not otherwise c”. These descriptions provide a clear understanding of the specific procedure being performed.

3. Procedure

1. Prepare the medication: The healthcare provider should ensure that the crizanlizumab-tmca medication is properly prepared according to the manufacturer’s instructions.
2. Verify patient information: Confirm the patient’s identity and ensure that the correct medication and dosage are being administered.
3. Administer the injection: Use aseptic technique to administer the crizanlizumab-tmca injection to the patient. Follow proper injection protocols and guidelines.
4. Monitor the patient: After the injection, closely monitor the patient for any adverse reactions or side effects. Provide appropriate care and intervention if necessary.
5. Document the procedure: Accurately document the administration of crizanlizumab-tmca, including the dosage, route of administration, and any relevant patient information.

4. When to use HCPCS code C9053

HCPCS code C9053 should be used when administering the crizanlizumab-tmca injection with a dosage of 1 mg. It is important to ensure that the specific medication and dosage match the description provided in the code. This code should only be used for the designated procedure and not for any other medications or dosages.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9053, healthcare providers need to ensure that the following documentation is included:

• Medical record documentation supporting the need for the crizanlizumab-tmca injection
• Date and time of the procedure
• Dosage and route of administration
• Any relevant patient information, such as allergies or contraindications

Providers should also follow the specific billing guidelines set forth by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9053 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. This code has a termination date of June 30, 2020, indicating that it is no longer in use after that date. As of the termination date, no maintenance actions have been taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code C9053 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, indicating that it is not applicable as HCPCS priced under one methodology.

It is important for healthcare providers to check with Medicare or other insurance carriers to determine the specific coverage and reimbursement policies for HCPCS code C9053.

8. Examples

Here are five examples of when HCPCS code C9053 should be billed:

1. A patient with sickle cell disease receiving the crizanlizumab-tmca injection as part of their treatment plan.
2. A patient with a history of frequent pain crises requiring the crizanlizumab-tmca injection for pain management.
3. A patient undergoing a scheduled procedure where the crizanlizumab-tmca injection is administered as a preventive measure.
4. A patient participating in a clinical trial where the crizanlizumab-tmca injection is being evaluated for its effectiveness.
5. A patient with a specific medical condition that has been determined to benefit from the crizanlizumab-tmca injection.