How To Use HCPCS Code C9064

HCPCS code C9064 describes the procedure of mitomycin pyelocalyceal instillation, 1 mg. This code is used to identify the administration of mitomycin, a chemotherapy drug, directly into the renal pelvis and calyces of the kidney. It is typically used to treat certain types of bladder cancer that have spread to the upper urinary tract.

1. What is HCPCS C9064?

HCPCS code C9064 is a specific code used to identify the procedure of mitomycin pyelocalyceal instillation, 1 mg. It is important to note that this code is only applicable for the administration of mitomycin into the renal pelvis and calyces of the kidney, and not for other routes of administration or different dosages of the drug.

2. Official Description

The official description of HCPCS code C9064 is “Mitomycin pyelocalyceal instillation, 1 mg”. The short description for this code is “Parenteral supp not othrws c”. This description accurately reflects the specific procedure and dosage associated with this code.

3. Procedure

1. Prepare the mitomycin solution according to the manufacturer’s instructions.
2. Ensure the patient is in a suitable position for the procedure, such as lying on their back with their legs elevated.
3. Cleanse the area around the urethral meatus with an antiseptic solution.
4. Insert a catheter into the urethra and advance it into the bladder.
5. Slowly instill the prepared mitomycin solution into the bladder through the catheter.
6. Once the solution is instilled, clamp the catheter to prevent leakage.
7. Allow the mitomycin solution to dwell in the bladder for the recommended duration, as specified by the healthcare provider.
8. After the dwell time, unclamp the catheter and allow the solution to drain out of the bladder.
9. Remove the catheter and ensure the patient is comfortable.

4. When to use HCPCS code C9064

HCPCS code C9064 should be used when performing the specific procedure of mitomycin pyelocalyceal instillation, 1 mg. It is important to ensure that the procedure is being performed in the renal pelvis and calyces of the kidney, as this code is not applicable for other routes of administration or different dosages of mitomycin.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9064, healthcare providers should ensure that the procedure is properly documented in the patient’s medical record. This documentation should include details such as the date of the procedure, the dosage of mitomycin administered, and any relevant clinical indications for the procedure. Additionally, providers should follow the appropriate billing guidelines and submit the claim with the necessary supporting documentation to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9064 was added to the Healthcare Common Procedure Coding System on January 1, 1985. It has an effective date of January 1, 1996. This code has a pricing indicator code of 57, which indicates that it is priced by other carriers. The multiple pricing indicator code for this code is A, indicating that it is not applicable as HCPCS priced under one methodology. It is important to note that HCPCS code C9064 was terminated on December 31, 2020, and is no longer valid for use.

7. Medicare and Insurance Coverage

Medicare coverage for HCPCS code C9064 may vary depending on the specific circumstances and guidelines set by Medicare. Providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for more information on coverage and reimbursement for this code. It is also important to check with other insurance carriers to determine their coverage policies for this procedure.

8. Examples

Here are five examples of when HCPCS code C9064 should be billed:

1. A patient with bladder cancer that has spread to the renal pelvis and calyces undergoes mitomycin pyelocalyceal instillation as part of their treatment plan.
2. A healthcare provider performs mitomycin pyelocalyceal instillation in a patient with recurrent upper urinary tract urothelial carcinoma.
3. A patient with a history of bladder cancer undergoes surveillance cystoscopy, and during the procedure, mitomycin is instilled into the renal pelvis and calyces.
4. A urologist administers mitomycin pyelocalyceal instillation in a patient with carcinoma in situ involving the upper urinary tract.
5. A patient with a history of bladder cancer undergoes a repeat mitomycin pyelocalyceal instillation to prevent recurrence in the renal pelvis and calyces.