How To Use HCPCS Code C9461

HCPCS code C9461 describes the use of Choline C 11 for diagnostic purposes, specifically for a per study dose. This code is used to identify the administration of Choline C 11, a radiopharmaceutical agent, which is used in positron emission tomography (PET) scans to detect and evaluate certain types of cancer.

1. What is HCPCS C9461?

HCPCS code C9461 is a specific code that is used to identify the administration of Choline C 11 for diagnostic purposes. It is important to note that this code is specific to the per study dose of Choline C 11, which is used in PET scans for cancer detection and evaluation.

2. Official Description

The official description of HCPCS code C9461 is “Choline c 11, diagnostic, per study dose.” This description accurately reflects the purpose and usage of this code. The short description for this code is “Enteral supp not otherwise c,” which indicates that it is related to enteral supplementation.

3. Procedure

1. The procedure for HCPCS code C9461 involves the administration of Choline C 11 to the patient.
2. Prior to the administration, the healthcare provider should ensure that the patient is properly prepared for the PET scan.
3. The Choline C 11 is typically administered intravenously, and the dosage may vary depending on the specific study requirements.
4. After the administration, the patient will undergo a PET scan to detect and evaluate the presence of cancer.
5. The results of the PET scan will be used by the healthcare provider to make a diagnosis and determine the appropriate treatment plan.

4. When to use HCPCS code C9461

HCPCS code C9461 should be used when a healthcare provider administers Choline C 11 for diagnostic purposes, specifically for a per study dose. This code is applicable for patients undergoing PET scans for cancer detection and evaluation.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9461, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the administration of Choline C 11
• Documentation of the PET scan procedure
• Documentation of the medical necessity for the use of Choline C 11

It is important to accurately document the details of the procedure and the medical necessity to support the billing of this code.

6. Historical Information and Code Maintenance

HCPCS code C9461 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has a termination date of December 31, 2016. This code has not undergone any maintenance actions, as indicated by the action code N, which means no maintenance for this code. The termination of this code suggests that it is no longer in use or has been replaced by a different code for similar procedures.

7. Medicare and Insurance Coverage

HCPCS code C9461 may have specific coverage instructions that apply, as indicated by the coverage code D. This means that there may be special coverage guidelines or requirements for Medicare and other insurance providers 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, which means that it is not applicable as HCPCS priced under one methodology. Healthcare providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for additional information on coverage and reimbursement.

8. Examples

Here are five examples of when HCPCS code C9461 should be billed:

1. A patient with a suspected prostate cancer undergoes a PET scan with Choline C 11 for diagnostic purposes.
2. A patient with a history of breast cancer undergoes a PET scan with Choline C 11 to evaluate the response to treatment.
3. A patient with suspected recurrent colorectal cancer undergoes a PET scan with Choline C 11 to determine the extent of the disease.
4. A patient with suspected lung cancer undergoes a PET scan with Choline C 11 to assess the presence of metastasis.
5. A patient with suspected brain tumor undergoes a PET scan with Choline C 11 to identify the location and characteristics of the tumor.