How To Use HCPCS Code C9158

HCPCS code C9158 describes the injection of risperidone, specifically the medication known as Uzedy, at a dosage of 1 mg. This code is used to identify and bill for this specific medication and dosage when administered to patients. In this article, we will explore the details of HCPCS code C9158, 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 C9158?

HCPCS code C9158 is a specific code that is used to identify the injection of risperidone, known as Uzedy, at a dosage of 1 mg. It is important to note that HCPCS codes are used for billing purposes and to provide a standardized way of identifying medical procedures, services, and supplies. This code specifically refers to the administration of risperidone through injection, and it is important for medical coders to accurately assign this code when billing for this specific medication and dosage.

2. Official Description

The official description of HCPCS code C9158 is “Injection, risperidone, (uzedy), 1 mg”. This description clearly indicates that this code is used to identify the injection of risperidone, specifically the medication Uzedy, at a dosage of 1 mg. The short description for this code is “Enteral supp not otherwise c”, which provides additional information about the nature of the procedure or service.

3. Procedure

1. The provider prepares the risperidone medication, ensuring that it is the Uzedy formulation and that the dosage is 1 mg.
2. The provider verifies the patient’s medical history, ensuring that risperidone is an appropriate medication for the patient’s condition.
3. The provider follows proper aseptic technique and prepares the injection site.
4. The provider administers the risperidone injection to the patient, ensuring accurate dosage and proper injection technique.
5. The provider monitors the patient for any immediate adverse reactions or side effects.
6. The provider documents the administration of the risperidone injection in the patient’s medical record.

4. When to use HCPCS code C9158

HCPCS code C9158 should be used when the provider administers the injection of risperidone, specifically the medication Uzedy, at a dosage of 1 mg. It is important to ensure that the medication and dosage match the description provided in the code. This code should only be used for the specific procedure described and should not be assigned for any other medications or dosages.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9158, healthcare providers need to ensure that they accurately document the administration of the risperidone injection. This includes documenting the medication used (Uzedy), the dosage (1 mg), and the date of administration. It is also important to include any relevant patient information and medical necessity documentation to support the use of this code. Proper documentation is crucial for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9158 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 pricing indicator code of 57, which indicates that it is priced by other carriers. The multiple pricing indicator code for this code is A, which means it is not applicable as HCPCS priced under one methodology. There have been no maintenance actions 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 C9158 is subject to special coverage instructions, as indicated by the coverage code D. This means that there may be specific guidelines or criteria that need to be met for Medicare or other insurance coverage. It is important for healthcare providers to review the specific coverage instructions and guidelines to ensure proper reimbursement for this procedure. The Medicare Carriers Manual Reference Section Number for this code is 2130, which provides additional information and guidance for billing and coverage.

8. Examples

Here are five examples of when HCPCS code C9158 should be billed:

1. A patient with a diagnosed mental health condition receives an injection of risperidone (Uzedy) at a dosage of 1 mg as part of their ongoing treatment plan.
2. A healthcare provider administers a risperidone injection (Uzedy) at a dosage of 1 mg to a patient in an acute psychiatric crisis to help manage their symptoms.
3. A patient with a history of schizophrenia receives a risperidone injection (Uzedy) at a dosage of 1 mg during a routine outpatient visit to maintain their medication regimen.
4. A healthcare provider administers a risperidone injection (Uzedy) at a dosage of 1 mg to a patient with bipolar disorder who is experiencing a manic episode and requires immediate intervention.
5. A patient with a diagnosed psychotic disorder receives a risperidone injection (Uzedy) at a dosage of 1 mg as part of their inpatient treatment plan.