How To Use HCPCS Code C9465

HCPCS code C9465 describes the use of hyaluronan or derivative, specifically durolane, for intra-articular injection per dose. This code is used to identify and bill for the administration of this specific substance for the treatment of joint-related conditions. In this article, we will explore the details of HCPCS code C9465, 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 C9465?

HCPCS code C9465 is used to identify the administration of hyaluronan or derivative, specifically durolane, through an intra-articular injection. This code is specific to the use of durolane and should not be used for other hyaluronan products or procedures. It is important to accurately assign this code to ensure proper billing and reimbursement for the provided service.

2. Official Description

The official description of HCPCS code C9465 is “Hyaluronan or derivative, durolane, for intra-articular injection, per dose.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. Prepare the patient for the intra-articular injection.
2. Cleanse the injection site with an appropriate antiseptic solution.
3. Assemble the necessary equipment, including the syringe and needle.
4. Draw up the appropriate dose of durolane into the syringe.
5. Identify the correct injection site within the joint.
6. Administer the injection slowly and carefully, ensuring proper placement within the joint space.
7. Monitor the patient for any adverse reactions or complications.
8. Provide post-injection instructions and follow-up care as necessary.

4. When to use HCPCS code C9465

HCPCS code C9465 should be used when administering hyaluronan or derivative, specifically durolane, through an intra-articular injection. This code is typically used for the treatment of joint-related conditions, such as osteoarthritis, where the use of durolane has been deemed medically necessary. It is important to review the specific guidelines and coverage instructions to ensure proper usage of this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9465, healthcare providers should ensure that the necessary documentation is in place to support the medical necessity of the procedure. This may include clinical notes, diagnostic test results, and any other relevant documentation. Additionally, providers should follow the specific billing guidelines set forth by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9465 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, indicating 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. 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

Medicare and insurance coverage for HCPCS code C9465 may vary. It is important to review the specific coverage guidelines and instructions provided by Medicare or other insurance carriers to determine if this code is payable. The Medicare Carriers Manual Reference Section Number for this code is 2130, which may provide additional information on coverage and reimbursement.

8. Examples

Here are five examples of when HCPCS code C9465 should be billed:

1. A patient with moderate osteoarthritis in their knee receives an intra-articular injection of durolane for pain management.
2. A patient with hip joint degeneration undergoes an intra-articular injection of durolane to improve joint mobility and reduce pain.
3. A patient with shoulder impingement syndrome receives an intra-articular injection of durolane to alleviate inflammation and pain.
4. A patient with temporomandibular joint disorder undergoes an intra-articular injection of durolane to improve jaw function and reduce discomfort.
5. A patient with ankle osteoarthritis receives an intra-articular injection of durolane to alleviate pain and improve joint function.