How To Use HCPCS Code C9455

HCPCS code C9455 describes the injection of siltuximab, with a dosage of 10 mg. This code is used to identify the specific procedure of administering siltuximab through injection. In this article, we will explore the details of HCPCS code C9455, including its official description, procedure, when to use it, billing guidelines, historical information, and Medicare and insurance coverage. Let’s dive in!

1. What is HCPCS C9455?

HCPCS code C9455 is used to identify the injection of siltuximab, with a dosage of 10 mg. It is important to note that this code is specific to the administration of siltuximab and should not be used for any other procedures or medications. Medical coders and healthcare providers should use this code when documenting and billing for the injection of siltuximab.

2. Official Description

The official description of HCPCS code C9455 is “Injection, siltuximab, 10 mg.” This description accurately represents the procedure being performed, which is the administration of siltuximab through injection. The short description for this code is “Enteral supp not otherwise c,” indicating that it is related to enteral support but does not fall under any other specific category.

3. Procedure

1. Prepare the necessary equipment and supplies for the injection of siltuximab.
2. Verify the patient’s identity and confirm the correct dosage of siltuximab.
3. Select an appropriate injection site, ensuring proper hygiene and aseptic technique.
4. Administer the siltuximab injection using the appropriate needle and syringe.
5. Monitor the patient for any adverse reactions or complications following the injection.
6. Document the procedure in the patient’s medical record, including the dosage administered and any relevant observations.

4. When to use HCPCS code C9455

HCPCS code C9455 should be used when the healthcare provider is administering siltuximab through injection. It is important to ensure that the patient meets the specific criteria for receiving siltuximab and that the injection is performed for the intended purpose. This code should not be used for any other procedures or medications.

5. Billing Guidelines and Documentation Requirements

When billing for the injection of siltuximab using HCPCS code C9455, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the patient’s medical necessity for receiving siltuximab.
• Documentation of the dosage administered and any relevant observations or complications.
• Proper coding and identification of HCPCS code C9455 on the claim form.

It is important to follow the specific billing guidelines provided by Medicare or other insurance carriers to ensure accurate and timely reimbursement for the procedure.

6. Historical Information and Code Maintenance

HCPCS code C9455 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 been terminated as of December 31, 2015. The termination of this code means that it is no longer valid for use in documenting or billing for the injection of siltuximab.

7. Medicare and Insurance Coverage

HCPCS code C9455 is classified under the HCPCS Coverage Code D, which indicates that special coverage instructions apply. Medicare and other insurance carriers may have specific guidelines and requirements for coverage of siltuximab injections. It is important to review the individual payer’s policies to determine the coverage and reimbursement for this procedure.

8. Examples

Here are five examples of when HCPCS code C9455 should be billed:

1. A patient with a diagnosed inflammatory condition receives a siltuximab injection as part of their treatment plan.
2. A healthcare provider administers a siltuximab injection to a patient with a confirmed diagnosis of Castleman disease.
3. A patient with recurrent fever of unknown origin receives a siltuximab injection to help manage their symptoms.
4. A healthcare provider administers a siltuximab injection to a patient with HIV-associated multicentric Castleman disease.
5. A patient with relapsed or refractory multicentric Castleman disease receives a siltuximab injection as a therapeutic intervention.