How To Use HCPCS Code C9472

HCPCS code C9472 describes the injection of talimogene laherparepvec, which contains 1 million plaque forming units (pfu). This code is used to identify the specific procedure of injecting talimogene laherparepvec into a patient. In this article, we will explore the details of HCPCS code C9472, 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 C9472?

HCPCS code C9472 is a specific code used to identify the injection of talimogene laherparepvec. This code is used to indicate the administration of this particular medication to a patient. It is important for medical coders to accurately assign this code to ensure proper documentation and billing.

2. Official Description

The official description of HCPCS code C9472 is “Injection, talimogene laherparepvec, 1 million plaque forming units (pfu)”. The short description for this code is “Parenteral supp not othrws c”. These descriptions provide a clear understanding of the procedure and the specific medication being administered.

3. Procedure

1. The provider prepares the talimogene laherparepvec medication according to the manufacturer’s instructions.
2. The provider ensures that the patient is in a suitable position for the injection.
3. The provider cleans the injection site with an appropriate antiseptic solution.
4. The provider uses a sterile syringe and needle to withdraw the appropriate dose of talimogene laherparepvec.
5. The provider injects the medication into the patient’s subcutaneous tissue or tumor site, following the recommended injection technique.
6. The provider disposes of the used syringe and needle in a sharps container.
7. The provider documents the administration of talimogene laherparepvec in the patient’s medical record.

4. When to use HCPCS code C9472

HCPCS code C9472 should be used when the provider administers talimogene laherparepvec to a patient. This code is specific to the injection of this particular medication and should not be used for any other procedures or medications. It is important to review the documentation and ensure that the injection meets the criteria for using this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9472, healthcare providers need to document the administration of talimogene laherparepvec in the patient’s medical record. This documentation should include the date of the injection, the dosage administered, the injection site, and any relevant patient information. It is important to follow the specific billing guidelines provided by Medicare or other insurance carriers to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9472 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

Medicare and other insurance carriers may provide coverage for HCPCS code C9472. The specific coverage instructions may apply, and it is important to review the individual carrier’s guidelines for reimbursement. The pricing of this service or supply is determined by other carriers, and it is essential to follow the pricing guidelines provided by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code C9472 should be billed:

1. A patient with advanced melanoma receives an injection of talimogene laherparepvec as part of their treatment plan.
2. A healthcare provider administers talimogene laherparepvec to a patient with a localized tumor.
3. A patient with recurrent head and neck cancer undergoes an injection of talimogene laherparepvec to target the tumor.
4. A provider administers talimogene laherparepvec to a patient with inoperable skin cancer.
5. A healthcare professional administers talimogene laherparepvec to a patient with metastatic melanoma.