How To Use HCPCS Code C9457

HCPCS code C9457 describes the injection of sulfur hexafluoride lipid microsphere per milliliter. This code is used to identify the specific procedure and is essential for medical coders to accurately bill for this service. In this article, we will explore the details of HCPCS code C9457, 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 C9457?

HCPCS code C9457 is used to identify the injection of sulfur hexafluoride lipid microsphere per milliliter. This procedure involves the administration of a specific substance to the patient. It is important for medical coders to assign this code accurately to ensure proper billing and reimbursement.

2. Official Description

The official description of HCPCS code C9457 is “Injection, sulfur hexafluoride lipid microsphere, per ml.” This description provides a clear and concise explanation of the procedure being performed.

3. Procedure

1. The provider prepares the sulfur hexafluoride lipid microsphere for injection.
2. The provider verifies the patient’s identity and obtains informed consent.
3. The provider cleans the injection site and prepares the necessary equipment.
4. The provider administers the sulfur hexafluoride lipid microsphere via injection.
5. The provider monitors the patient for any adverse reactions or complications.
6. The provider documents the procedure in the patient’s medical record.

4. When to use HCPCS code C9457

HCPCS code C9457 should be used when the provider performs the specific procedure of injecting sulfur hexafluoride lipid microsphere per milliliter. It is important to ensure that the documentation supports the use of this code and that the procedure meets the necessary criteria for reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9457, healthcare providers need to document the details of the procedure, including the dosage of sulfur hexafluoride lipid microsphere administered. It is essential to include the patient’s medical record number, date of service, and any relevant supporting documentation to substantiate the need for this procedure.

6. Historical Information and Code Maintenance

HCPCS code C9457 was added to the Healthcare Common Procedure Coding System on January 1, 1985. It has an effective date of January 1, 1996. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders to stay updated on any changes or revisions to this code.

7. Medicare and Insurance Coverage

HCPCS code C9457 may have specific coverage instructions that apply, as indicated by the coverage code D. Medicare and other insurance carriers may have pricing indicators and multiple pricing indicators that determine how this service or supply is priced. It is important to review the Medicare Carriers Manual reference section number 2130 for any additional guidance on coverage and reimbursement.

8. Examples

Here are five examples of when HCPCS code C9457 should be billed:

1. A patient with a known liver lesion undergoes an ultrasound-guided injection of sulfur hexafluoride lipid microsphere for diagnostic purposes.
2. A patient with a history of pulmonary embolism receives an injection of sulfur hexafluoride lipid microsphere for a pulmonary angiography.
3. A patient with a suspected brain tumor undergoes a magnetic resonance imaging (MRI) scan with the administration of sulfur hexafluoride lipid microsphere for enhanced imaging.
4. A patient with a known cardiac abnormality undergoes an echocardiogram with the injection of sulfur hexafluoride lipid microsphere for improved visualization of the heart.
5. A patient with a suspected gastrointestinal bleed undergoes a computed tomography (CT) angiography with the administration of sulfur hexafluoride lipid microsphere for better visualization of the blood vessels.